Department of Obstetrics and Gynaecology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
Ultrasound Obstet Gynecol. 2017 Dec;50(6):683-696. doi: 10.1002/uog.17410.
The aim of this systematic review and meta-analysis was to describe comprehensively the pattern of cardiac remodeling during normotensive human singleton pregnancy and to compare it with that of pregnancy complicated by hypertension.
We performed a meta-analysis of the current literature on cardiac remodeling during normotensive and complicated pregnancies. Literature was retrieved from PubMed (NCBI) and EMBASE (Ovid) databases. Included studies needed to report a reference measurement (matched non-pregnant control group, prepregnancy or postpartum) and measurements made during predetermined gestational-age intervals. Mean differences between reference and pregnancy data were calculated using the random-effects model described by DerSimonian and Laird.
Forty-eight studies were included in the meta-analysis, with publication dates ranging from 1977 to 2016. During normotensive pregnancy, most geometric indices started to increase in the second trimester. Left ventricular mass (LVM) increased by 28.36 (95% CI, 19.73-37.00) g (24%), and relative wall thickness (RWT) increased by 0.03 (95% CI, 0.02-0.05) (10%) compared with those in the reference group. During hypertensive pregnancy, LVM and RWT increased more than during normotensive pregnancy (92 (95% CI, 75.46-108.54) g (95%) and 0.14 (95% CI, 0.09-0.19) (56%), respectively).
During normotensive pregnancy, most cardiac geometric indices change from the second trimester onwards. Both LVM and RWT increase, by 20% and 10%, respectively, consistent with concentric rather than eccentric remodeling. Cardiac adaptation in hypertensive pregnancy deviates from that in healthy pregnancy by a greater change in LVM (95% increase from reference) and RWT (56% increase from reference). Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
本系统评价和荟萃分析旨在全面描述正常血压单胎妊娠期间的心脏重构模式，并将其与高血压合并妊娠期间的心脏重构模式进行比较。
我们对正常血压和复杂妊娠期间心脏重构的现有文献进行了荟萃分析。文献从 PubMed（NCBI）和 EMBASE（Ovid）数据库中检索。纳入的研究需要报告参考测量值（匹配的非妊娠对照组、孕前或产后）和在预定的妊娠龄间隔内进行的测量值。使用 DerSimonian 和 Laird 描述的随机效应模型计算参考数据和妊娠数据之间的均值差异。
荟萃分析纳入了 48 项研究，发表日期从 1977 年至 2016 年不等。在正常血压妊娠期间，大多数几何指数在妊娠中期开始增加。左心室质量（LVM）增加 28.36 g（95%置信区间，19.73-37.00）（24%），相对壁厚度（RWT）增加 0.03（95%置信区间，0.02-0.05）（10%），与参考组相比。在高血压妊娠期间，LVM 和 RWT 的增加超过正常血压妊娠（92 g（95%置信区间，75.46-108.54）（95%）和 0.14（95%置信区间，0.09-0.19）（56%））。
在正常血压妊娠期间，大多数心脏几何指数从妊娠中期开始发生变化。LVM 和 RWT 均增加，分别增加 20%和 10%，与向心性重构而非偏心性重构一致。高血压妊娠期间的心脏适应性通过 LVM（参考值增加 95%）和 RWT（参考值增加 56%）的更大变化而偏离健康妊娠的适应性。版权所有 © 2017 ISUOG。由 John Wiley & Sons Ltd 出版。
