The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, United Kingdom.
East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Canada Avenue, Surrey, United Kingdom.
Am J Obstet Gynecol. 2023 Mar;228(3):283-291. doi: 10.1016/j.ajog.2022.09.025. Epub 2022 Sep 20.
This study aimed to systematically assess perinatal outcomes of pregnancies complicated by maternal cardiomyopathy.
PubMed, Ovid Embase, Ovid MEDLINE, the Cochrane Library, and ClinicalTrials.gov were systematically searched from inception to August 25, 2022.
Observational cohort, case-control, and case-cohort studies in human populations were included if they reported predefined perinatal outcomes in pregnant women with cardiomyopathy (any subtype) and an appropriate control population (either pregnant women with no known cardiac disease or pregnant women with noncardiomyopathy cardiac disease).
Of note, 2 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 Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines.
Here, 13 studies (representing 2,291,024 pregnancies) were eligible for inclusion. Perinatal death was more likely in neonates born to women with cardiomyopathy than in (1) neonates born to women with no cardiac disease (stillbirth: odds ratio, 20.82; 95% confidence interval, 6.68-64.95; I = not available; P<.00001; neonatal mortality: odds ratio, 6.75; 95% confidence interval, 3.54-12.89; I=0%; P<.00001) and (2) neonates born to women with other forms of cardiac disease (stillbirth: odds ratio, 3.75; 95% confidence interval, 1.86-7.59; I=0%; P=.0002; neonatal mortality: odds ratio, 2.42; 95% confidence interval, 1.39-4.21; I=0%; P=.002). Pregnancies affected by maternal cardiomyopathy were significantly more likely to result in preterm birth (odds ratio, 2.21; 95% confidence interval, 1.31-3.73; I=77%; P=.003) and small-for-gestational-age neonates (odds ratio, 2.97; 95% confidence interval, 2.38-3.70; I=47%; P<.00001), both major causes of short- and long-term morbidities, than pregnancies affected by other forms of cardiac disease.
There was an increased likelihood of adverse perinatal outcomes in pregnancies affected by maternal cardiomyopathy compared with both pregnancies affected by noncardiomyopathy cardiac disease and pregnancies without cardiac disease. Women with cardiomyopathy who plan to get pregnant should receive detailed counseling regarding these risks and have their pregnancies managed by experienced multidisciplinary teams that can provide close fetal monitoring and neonatology expertise.
本研究旨在系统评估母体心肌病妊娠的围产期结局。
从建库至 2022 年 8 月 25 日，我们系统性地检索了 PubMed、Ovid Embase、Ovid MEDLINE、Cochrane 图书馆和 ClinicalTrials.gov 中的文献。
如果研究报告了患有心肌病（任何类型）的孕妇和适当对照人群（无已知心脏疾病的孕妇或患有非心肌病心脏疾病的孕妇）的预先定义的围产期结局，则包括观察性队列、病例对照和病例-队列研究。
请注意，由 2 名评审员独立评估文章的入选标准和偏倚风险，如有分歧则由第 3 名评审员解决。根据系统评价和荟萃分析的首选报告项目以及观察性研究荟萃分析的指南，提取和综合数据。
这里纳入了 13 项研究（代表 2291024 例妊娠）。与（1）无心脏疾病的孕妇所生新生儿（死产：比值比，20.82；95%置信区间，6.68-64.95；I=无；P<.00001；新生儿死亡率：比值比，6.75；95%置信区间，3.54-12.89；I=0%；P<.00001）和（2）患有其他类型心脏疾病的孕妇所生新生儿（死产：比值比，3.75；95%置信区间，1.86-7.59；I=0%；P=.0002；新生儿死亡率：比值比，2.42；95%置信区间，1.39-4.21；I=0%；P=.002）相比，患有心肌病的孕妇所生新生儿更有可能发生死产和早产（比值比，2.21；95%置信区间，1.31-3.73；I=77%；P=.003）以及小于胎龄儿（比值比，2.97；95%置信区间，2.38-3.70；I=47%；P<.00001），这些都是短期和长期发病率的主要原因，与患有其他类型心脏疾病的孕妇相比。
与患有非心肌病心脏疾病的孕妇和无心脏疾病的孕妇相比，患有母体心肌病的孕妇发生不良围产期结局的可能性更大。计划怀孕的心肌病女性应接受详细咨询，了解这些风险，并由经验丰富的多学科团队管理妊娠，该团队可以提供密切的胎儿监测和新生儿科专业知识。
