College of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia.
College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
PLoS One. 2021 Jun 29;16(6):e0253581. doi: 10.1371/journal.pone.0253581. eCollection 2021.
Associations between rheumatic heart disease (RHD) in pregnancy and fetal outcomes are relatively unknown. This study aimed to review rates and predictors of major adverse fetal outcomes of RHD in pregnancy.
Medline (Ovid), Pubmed, EMcare, Scopus, CINAHL, Informit, and WHOICTRP databases were searched for studies that reported rates of adverse perinatal events in women with RHD during pregnancy. Outcomes included preterm birth, intra-uterine growth restriction (IUGR), low-birth weight (LBW), perinatal death and percutaneous balloon mitral valvuloplasty intervention. Meta-analysis of fetal events by the New-York Heart Association (NYHA) heart failure classification, and the Mitral-valve Area (MVA) severity score was performed with unadjusted random effects models and heterogeneity of risk ratios (RR) was assessed with the I2 statistic. Quality of evidence was evaluated using the GRADE approach. The study was registered in PROSPERO (CRD42020161529).
The search identified 5949 non-duplicate records of which 136 full-text articles were assessed for eligibility and 22 studies included, 11 studies were eligible for meta-analyses. In 3928 pregnancies, high rates of preterm birth (9.35%-42.97%), LBW (12.98%-39.70%), IUGR (6.76%-22.40%) and perinatal death (0.00%-9.41%) were reported. NYHA III/IV pre-pregnancy was associated with higher rates of preterm birth (5 studies, RR 2.86, 95%CI 1.54-5.33), and perinatal death (6 studies, RR 3.23, 1.92-5.44). Moderate /severe mitral stenosis (MS) was associated with higher rates of preterm birth (3 studies, RR 2.05, 95%CI 1.02-4.11) and IUGR (3 studies, RR 2.46, 95%CI 1.02-5.95).
RHD during pregnancy is associated with adverse fetal outcomes. Maternal NYHA III/IV and moderate/severe MS in particular may predict poor prognosis.
风湿性心脏病（RHD）与妊娠胎儿结局之间的关联尚不清楚。本研究旨在综述妊娠合并 RHD 的主要不良胎儿结局的发生率和预测因素。
检索 Medline（Ovid）、PubMed、EMcare、Scopus、CINAHL、Informit 和 WHOICTRP 数据库，以获取报告妊娠合并 RHD 患者不良围生期事件发生率的研究。结局包括早产、宫内生长受限（IUGR）、低出生体重（LBW）、围产儿死亡和经皮二尖瓣球囊成形术干预。采用未经调整的随机效应模型对纽约心脏协会（NYHA）心力衰竭分类和二尖瓣瓣口面积（MVA）严重程度评分的胎儿结局进行荟萃分析，并使用 I²统计评估风险比（RR）的异质性。使用 GRADE 方法评估证据质量。该研究已在 PROSPERO（CRD42020161529）中注册。
搜索共确定了 5949 条非重复记录，其中有 136 篇全文文章被评估为合格，有 22 项研究符合纳入标准，其中有 11 项研究可进行荟萃分析。在 3928 例妊娠中，早产（9.35%-42.97%）、低出生体重（12.98%-39.70%）、宫内生长受限（6.76%-22.40%）和围产儿死亡（0.00%-9.41%）的发生率较高。孕前 NYHA III/IV 与早产（5 项研究，RR 2.86，95%CI 1.54-5.33）和围产儿死亡（6 项研究，RR 3.23，95%CI 1.92-5.44）的发生率较高相关。中重度二尖瓣狭窄（MS）与早产（3 项研究，RR 2.05，95%CI 1.02-4.11）和宫内生长受限（3 项研究，RR 2.46，95%CI 1.02-5.95）的发生率较高相关。
妊娠合并 RHD 与不良胎儿结局相关。特别是母体 NYHA III/IV 和中重度 MS 可能预示着不良预后。
