Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Adv Med Sci. 2019 Sep;64(2):415-422. doi: 10.1016/j.advms.2019.07.003. Epub 2019 Sep 12.
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide, and is associated with increased morbidity and mortality. However, the incidence and maternal/fetal outcomes of AF in pregnancy remain unclear. This study's aims were to investigate the pooled incidence of AF in pregnant women and to assess maternal/fetal outcomes of AF in pregnancy.
A literature search for studies that reported incidence of AF in pregnancy, was conducted using MEDLINE, EMBASE and Cochrane Database from inception through May 2018. Pooled incidence with 95%CI were calculated using a random-effect model. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42018095955).
We identified 7 cohort studies including 301,638 pregnancies. The pooled estimated incidence of AF in pregnancy among women with no known heart disease, and those with structural heart disease was 0.3% (95%CI: 0.01%-40.6%) and 2.2% (95%CI: 0.96%-5.01%), respectively. Among women with known AF, the pooled estimated incidence of recurrent AF in pregnancy was 39.2% (95%CI: 16.9%-67.2%). The pooled estimated incidence of pre-eclampsia and congestive heart failure among pregnant patients with AF was 4.1% (95%CI: 2.1%-7.8%) and 9.6% (95%CI: 5.7%-15.9%), respectively. The pooled estimated incidence of fetal events including premature birth, small for gestational age, respiratory distress syndrome, intraventricular hemorrhage, death was 26.6% (95%CI: 20.4%-34.0%).
The overall estimated incidence of AF and recurrent AF during pregnancy is as high as 2.2% and 39.2%, respectively. AF during pregnancy may result in poor maternal and fetal outcomes.
心房颤动（AF）是全球最常见的持续性心律失常，与发病率和死亡率的增加有关。然而，妊娠期间 AF 的发生率和母婴结局仍不清楚。本研究旨在调查孕妇中 AF 的汇总发生率，并评估妊娠期间 AF 的母婴结局。
使用 MEDLINE、EMBASE 和 Cochrane 数据库，从成立到 2018 年 5 月，对报道妊娠期间 AF 发生率的研究进行文献检索。使用随机效应模型计算合并发生率及其 95%CI。本荟萃分析的方案已在 PROSPERO（国际前瞻性系统评价注册中心；编号：CRD42018095955）中注册。
我们共纳入了 7 项队列研究，包括 301638 例妊娠。在无已知心脏病和结构性心脏病的女性中，妊娠期间 AF 的汇总估计发生率分别为 0.3%（95%CI：0.01%-40.6%）和 2.2%（95%CI：0.96%-5.01%）。在已知 AF 的女性中，妊娠期间复发性 AF 的汇总估计发生率为 39.2%（95%CI：16.9%-67.2%）。妊娠合并 AF 的患者中，子痫前期和充血性心力衰竭的汇总估计发生率分别为 4.1%（95%CI：2.1%-7.8%）和 9.6%（95%CI：5.7%-15.9%）。包括早产、小于胎龄儿、呼吸窘迫综合征、脑室出血和死亡在内的胎儿事件的汇总估计发生率为 26.6%（95%CI：20.4%-34.0%）。
妊娠期间 AF 和复发性 AF 的总体估计发生率分别高达 2.2%和 39.2%。妊娠期间的 AF 可能导致母婴结局不良。
