Emergency Medicine, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands.
Knight Cardiovascular Institute, Oregon Health Science University, Portland, Oregon, USA.
Heart. 2019 Jun;105(11):873-880. doi: 10.1136/heartjnl-2018-314364. Epub 2019 Feb 21.
Studies on pregnancy risk in women with ischaemic heart disease (IHD) have mainly excluded pregnancies in women with pre-existent IHD. There is a need for better information about the pregnancy risks in these women and their offspring.
We performed a systematic review searching the PubMed/MEDLINE public database for pregnancy in women with pre-existent IHD analysing the cardiac, obstetric and fetal/neonatal outcome of pregnancy in women with pre-existing IHD. Individual patient data were requested from large series. The primary outcome endpoints was a composite of ischaemic complications including maternal death, acute coronary syndrome and ventricular tachycardia.
116 women with pre-existent IHD had 124 pregnancies including one twin pregnancy. They had a 21% chance of having an uncomplicated pregnancy (completed pregnancy without cardiovascular, obstetric or fetal/neonatal complications, n=26). Primary (ischaemic) endpoints occurred in 9% (n=11). Women with atherosclerosis had more cardiovascular complications compared with pregnancies in women with other underlying pathology for IHD (50%vs23%, P=0.02) but no significant difference in occurrence of primary endpoints (13% vs 9%, P=0.53). There were two maternal cardiac deaths (2%), one of which occurred in the 18th week of pregnancy and the other postpartum. Obstetric complications occurred in 58% (n=65) of pregnancies and fetal/neonatal complications in 42% (n=47).
Pregnancies in women with pre-existing IHD are high-risk pregnancies. These women have a high risk of ischaemic cardiovascular complications including 2% maternal mortality. The risk of ischaemic complications is especially high among women with atherosclerotic coronary artery disease.
关于患有缺血性心脏病（IHD）的女性妊娠风险的研究主要排除了患有先存 IHD 的女性的妊娠。因此，需要更好地了解这些女性及其后代的妊娠风险。
我们进行了一项系统评价，通过检索 PubMed/MEDLINE 公共数据库中患有先存 IHD 的女性的妊娠情况，分析了患有先存 IHD 的女性妊娠的心脏、产科和胎儿/新生儿结局。我们从大型系列中请求了个体患者数据。主要结局终点是包括母体死亡、急性冠状动脉综合征和室性心动过速在内的缺血性并发症的复合结局。
116 名患有先存 IHD 的女性有 124 次妊娠，其中包括一次双胞胎妊娠。她们有 21%的机会无并发症妊娠（完成妊娠且无心血管、产科或胎儿/新生儿并发症，n=26）。主要（缺血性）终点发生在 9%（n=11）的患者中。与患有其他 IHD 潜在病理学的妊娠相比，患有动脉粥样硬化的女性发生心血管并发症的可能性更高（50%比 23%，P=0.02），但主要终点的发生率无显著差异（13%比 9%，P=0.53）。有 2 例（2%）母亲心源性死亡，其中 1 例发生在妊娠第 18 周，另 1 例发生在产后。产科并发症发生在 58%（n=65）的妊娠中，胎儿/新生儿并发症发生在 42%（n=47）的妊娠中。
患有先存 IHD 的女性的妊娠属于高危妊娠。这些女性发生缺血性心血管并发症的风险较高，包括 2%的母体死亡率。在患有动脉粥样硬化性冠状动脉疾病的女性中，缺血性并发症的风险尤其高。
