School of Medical Education, Newcastle University, Framlington Place, Newcastle Upon Tyne, United Kingdom.
East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Surrey, United Kingdom.
Am J Obstet Gynecol. 2022 Oct;227(4):582-592. doi: 10.1016/j.ajog.2022.05.039. Epub 2022 May 21.
This study aimed to systematically assess the impact of cardiomyopathy on maternal pregnancy outcomes.
PubMed, Ovid Embase, Ovid MEDLINE, Cochrane Library, and ClinicalTrials.gov were systematically searched from inception to April 24, 2022.
Observational cohort, case-control, and case-cohort studies in human populations were included if they reported predefined maternal outcomes for pregnant women with cardiomyopathy (any subtype) and for an appropriate control population (pregnant women with no known heart disease or pregnant women with noncardiomyopathy heart disease).
Two reviewers independently assessed the articles for eligibility and risk of bias, and conflicts were resolved by a third reviewer. Data were extracted and synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analyses of Observational Studies in Epidemiology guidelines.
A total of 14 studies (n=57,539,306 pregnancies) were eligible for inclusion. Women with cardiomyopathy were more likely to deliver by cesarean delivery than women with no heart disease (odds ratio, 2.96; 95% confidence interval, 2.47-3.55; I=95%; P≤.00001) or women with noncardiomyopathy heart disease (odds ratio, 1.90; 95% confidence interval, 1.62-2.22; I=91%; P<.00001). Having cardiomyopathy conferred a greater risk for experiencing severe maternal adverse cardiovascular events during pregnancy when compared with not having any heart disease (odds ratio, 206.64; 95% confidence interval, 192.09-222.28; I=73%; P<.0001) or having noncardiomyopathy heart disease (odds ratio, 7.09; 95% confidence interval; 6.08-8.27; I=88%; P<.00001). In-hospital mortality was significantly higher among women with cardiomyopathy than among women with no heart disease (odds ratio, 126.67; 95% confidence interval, 43.01-373.07; I=87%; P<.00001) or among women with noncardiomyopathy heart disease (odds ratio, 4.30; 95% confidence interval, 3.42-5.40; I=0%; P<.00001).
Pregnant women with cardiomyopathy have increased risks for adverse maternal outcomes, including maternal death, when compared with both women with no heart disease and women with noncardiomyopathy heart disease. Our results highlight the importance of preconception risk assessments to allow for informed decision-making before pregnancy. Pregnancies affected by cardiomyopathy are high risk and should be managed by expert, multidisciplinary obstetrical and cardiology teams.
本研究旨在系统评估心肌病对孕产妇妊娠结局的影响。
从建库至 2022 年 4 月 24 日，我们系统地检索了 PubMed、Ovid Embase、Ovid MEDLINE、Cochrane 图书馆和 ClinicalTrials.gov 中的文献。
纳入人群为患有心肌病（任何类型）的孕妇和适当对照人群（无已知心脏病的孕妇或患有非心肌病性心脏病的孕妇）的前瞻性队列研究、病例对照研究和病例-队列研究，如果他们报告了预先确定的孕产妇结局。
两名审查员独立评估文章的入选标准和偏倚风险，如果存在分歧，则由第三名审查员解决。根据系统评价和荟萃分析的首选报告项目以及流行病学中的观察性研究荟萃分析指南，提取和综合数据。
共有 14 项研究（n=57539306 例妊娠）符合纳入标准。与无心脏病的孕妇（比值比，2.96；95%置信区间，2.47-3.55；I=95%；P≤0.00001）或患有非心肌病性心脏病的孕妇（比值比，1.90；95%置信区间，1.62-2.22；I=91%；P<.00001）相比，患有心肌病的孕妇更有可能通过剖宫产分娩。与无心脏病的孕妇（比值比，206.64；95%置信区间，192.09-222.28；I=73%；P<.0001）或患有非心肌病性心脏病的孕妇（比值比，7.09；95%置信区间；6.08-8.27；I=88%；P<.00001）相比，患有心肌病的孕妇在妊娠期间发生严重不良心血管事件的风险更高。与无心脏病的孕妇（比值比，126.67；95%置信区间，43.01-373.07；I=87%；P<.00001）或患有非心肌病性心脏病的孕妇（比值比，4.30；95%置信区间，3.42-5.40；I=0%；P<.00001）相比，患有心肌病的孕妇的院内死亡率明显更高。
与无心脏病的孕妇和患有非心肌病性心脏病的孕妇相比，患有心肌病的孕妇发生不良孕产妇结局（包括孕产妇死亡）的风险增加。我们的研究结果强调了在怀孕前进行孕前风险评估的重要性，以便做出知情决策。受心肌病影响的妊娠风险较高，应由专家多学科产科和心脏病学团队进行管理。
