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Original research
Pregnancy outcomes in women with significant valve disease: a systematic review and meta-analysis
  1. Robin Alexandra Ducas1,2,
  2. David A Javier2,
  3. Rohan D’Souza3,
  4. Candice K Silversides2,4,
  5. Wendy Tsang2
  1. 1 Section of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada
  2. 2 Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
  3. 3 Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
  4. 4 Division of Cardiology, University of Toronto Pregnancy and Heart Disease Program, Mount Sinai Hospital and Univeristy Health Network, Toronto, Ontario, Canada
  1. Correspondence to Wendy Tsang, Cardiology, University of Toronto, Toronto, ON M5G 2C4, Canada; wendy.tsang{at}uhn.ca

Abstract

Objective 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.

Methods 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).

Results 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%).

Conclusions 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.

  • valvular heart disease
  • pregnancy
  • meta-analysis
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Footnotes

  • Contributors RAD Study concept, generation of search strategy, abstract review and full text review. Data extraction and analysis. Manuscript writing. Final approval. DAJ Abstract review and full text review. Data extraction and analysis. Final approval. RD’S Expert review of content. Statistical analysis and interpretation. Final approval. CKS Study concept, generation of search strategy, data evaluation and adjudication for meta-analysis. Mansucript writing.Final approval. WT Study concept, generation of search strategy, expert review of content. Data analysis. Manuscript writing. Final approval. Guarantor of the content.

  • Funding WT is supported by a Heart and Stroke Foundation of Canada National New Investigator Award.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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