Section of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada.
Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Heart. 2020 Apr;106(7):512-519. doi: 10.1136/heartjnl-2019-315859. Epub 2020 Feb 13.
To perform a systematic review and meta-analysis of maternal/fetal outcomes in pregnant women with moderate/severe native valvular heart disease (VHD) from medium/higher Human Development Index (HDI) countries.
OvidSP platform databases were searched (1985-January 2019) to identify studies reporting pregnancy outcomes in women with moderate/severe VHD. The primary maternal outcome was maternal mortality. The primary fetal/neonatal outcome was stillbirth and neonatal death. Pooled incidences and 95% confidence intervals (CI) of maternal/fetal outcomes could only be calculated from studies involving mitral stenosis (MS) or aortic stenosis (AS).
Twelve studies on 646 pregnancies were included. Pregnant women with severe MS had mortality rates of 3% (95% CI, 0% to 6%), pulmonary oedema 37% (23%-51%) and new/recurrent arrhythmias 16% (1%-25%). Their stillbirth, neonatal death and preterm birth rates were 4% (1%-7%), 2% (0%-4%), and 18% (7%-29%), respectively. Women with moderate MS had mortality rates of 1%(0%-2%), pulmonary oedema 18% (2%-33%), new/recurrent arrhythmias 5% (1%-9%), stillbirth 2% (1%-4%) and preterm birth 10%(2%-17%).Pregnant women with severe AS had a risk of mortality of 2% (0%-5%), pulmonary oedema 9% (2%-15%), and new/recurrent arrhythmias 4% (0%-7%). Their stillbirth, neonatal death and preterm birth rates were 2% (0%-5%), 3% (0%-6%) and 14%(4%-24%), respectively. No maternal/neonatal deaths were reported in moderate AS, however women experienced pulmonary oedema (8%; 0%-20%), new/recurrent arrhythmias (2%; 0%-5%), and preterm birth (13%; 6%-20%).
Women with moderate/severe MS and AS are at risk for adverse maternal and fetal/neonatal outcomes. They should receive preconception counseling and pregnancy care by teams with pregnancy and heart disease experience.
对中/高人类发展指数（HDI）国家中患有中度/重度原发性瓣膜性心脏病（VHD）的孕妇的母婴结局进行系统回顾和荟萃分析。
在 OvidSP 平台数据库中进行检索（1985 年 1 月至 2019 年 1 月），以确定报告中重度 VHD 孕妇妊娠结局的研究。主要的母体结局是孕产妇死亡率。主要的胎儿/新生儿结局是死胎和新生儿死亡。只有纳入二尖瓣狭窄（MS）或主动脉瓣狭窄（AS）研究才能计算母体/胎儿结局的合并发生率和 95%置信区间（CI）。
纳入了 12 项关于 646 例妊娠的研究。重度 MS 孕妇的死亡率为 3%（95%CI，0%至 6%），肺水肿发生率为 37%（23%至 51%），新发/复发心律失常发生率为 16%（1%至 25%）。其死胎、新生儿死亡和早产率分别为 4%（1%至 7%）、2%（0%至 4%）和 18%（7%至 29%）。中度 MS 孕妇的死亡率为 1%（0%至 2%），肺水肿发生率为 18%（2%至 33%），新发/复发心律失常发生率为 5%（1%至 9%），死胎率为 2%（1%至 4%），早产率为 10%（2%至 17%）。重度 AS 孕妇的死亡率风险为 2%（0%至 5%），肺水肿发生率为 9%（2%至 15%），新发/复发心律失常发生率为 4%（0%至 7%）。其死胎、新生儿死亡和早产率分别为 2%（0%至 5%）、3%（0%至 6%）和 14%（4%至 24%）。中度 AS 孕妇未报告母婴死亡，但出现肺水肿（8%；0%至 20%）、新发/复发心律失常（2%；0%至 5%）和早产（13%；6%至 20%）。
患有中度/重度 MS 和 AS 的孕妇有发生不良母婴和胎儿/新生儿结局的风险。她们应该接受有妊娠和心脏病经验的团队的孕前咨询和妊娠护理。
