Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
Department of Obstetrics and Gynaecology, Katutura State Hospital, Windhoek, Namibia.
Trop Med Int Health. 2020 Jun;25(6):673-686. doi: 10.1111/tmi.13386. Epub 2020 Mar 22.
To assess the frequency of maternal death (MD) due to cardiac disease in low- and middle-income countries (LMIC).
Systematic review searching Medline, EMBASE, Web of Science, Cochrane Library, Emcare, LILACS, African Index Medicus, IMEMR, IndMED, WPRIM, IMSEAR up to 01/Nov/2017. Maternal mortality reports from LMIC reviewing all MD in a given geographical area were included. Hospital-based reports or those solely based on verbal autopsies were excluded. Numbers of MD and cardiac-related deaths were extracted. We calculated cardiac disease MMR (cMMR, cardiac-related MD/100 000 live births) and proportion of cardiac-related MDs among all MDs. Frequency of cardiac MD was compared with the MMR of the country.
Forty-seven reports were included, which reported on 38,486 maternal deaths in LMIC. Reported cMMR ranged from 0/100 000 live births (Moldova, Ghana) to 31.9/100 000 (Zimbabwe). The proportion of cardiac-related MD ranged from 0% (Moldova, Ghana) to 24.8% (Sri Lanka). In countries with a higher MMR, cMMR was also higher. However, the proportion of cardiac-related MD was higher in countries with a lower MMR.
The burden of cardiac-related mortality is difficult to assess due limited availability of mortality reports. The proportion of cardiac deaths among all MD appeared to be higher in countries with a lower MMR. This is in line with what has been called 'obstetric transition': pre-existing medical diseases including cardiac disease are becoming relatively more important where the MMR falls.
评估中低收入国家（LMIC）因心脏病导致的孕产妇死亡（MD）的频率。
系统检索 Medline、EMBASE、Web of Science、Cochrane Library、Emcare、LILACS、非洲医学索引、IMEMR、IndMED、WPRIM 和 IMSEAR，截至 2017 年 11 月 1 日。纳入了在特定地理区域内审查所有 MD 的 LMIC 孕产妇死亡率报告。排除了基于医院的报告或仅基于口头尸检的报告。提取 MD 和与心脏相关的死亡人数。我们计算了心脏病 MM（cMMR，与心脏相关的 MD/每 10 万活产）和所有 MD 中与心脏相关的 MD 比例。比较了心脏病 MD 的发生率与国家的 MM 率。
纳入了 47 份报告，报告了 LMIC 中 38486 例孕产妇死亡。报告的 cMMR 范围从 0/100000 活产（摩尔多瓦、加纳）到 31.9/100000（津巴布韦）。与心脏相关的 MD 比例范围从 0%（摩尔多瓦、加纳）到 24.8%（斯里兰卡）。在 MM 率较高的国家，cMMR 也较高。然而，在 MM 率较低的国家，与心脏相关的 MD 比例较高。
由于死亡率报告的有限可用性，评估与心脏相关的死亡率的负担很困难。在 MM 率较低的国家，所有 MD 中与心脏相关的死亡比例似乎更高。这与所谓的“产科转型”是一致的：在 MM 下降的情况下，包括心脏病在内的先前存在的疾病变得相对更为重要。
