Pregnant women with cardiomyopathy are at increased risk of adverse effects


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Adverse maternal and cardiovascular outcomes were more likely in pregnant women with cardiomyopathy than in those with no or different heart disease, results from a systematic review and meta-analysis showed.

“Our results underscore the importance of prenatal counseling in ensuring that women with cardiomyopathy make informed choices about the risks associated with pregnancy and underscore the need for close prenatal monitoring by multidisciplinary teams experienced in maternal cardiology account given the increased likelihood of serious adverse maternal outcomes,” Elizabeth J. EggletonBSc, a trainee health care scientist at Newcastle University Medical School in Newcastle upon Tyne, England, and his colleagues wrote in the American Journal of Obstetrics and Gynecology.

Eggleton and colleagues reviewed 14 studies published before April 24, 2022, which compared outcomes in women with cardiomyopathy to those in women without known heart disease — who the researchers referred to as healthy women — or with non-cardiomyopathy heart disease. The studies examined predefined measures for mode of delivery, left ventricular ejection fraction, major adverse cardiovascular events (MACE), and non-MACE outcomes.

Of the 14 studies reviewed – which included 57,539,306 pregnancies worldwide – eight had a low risk of bias, one had a moderate risk of bias and five had a high risk of bias. However, studies at high risk of bias did not affect the results of meta-analyses, the researchers said.

Delivery method

Women with cardiomyopathy were more likely to have cesarean delivery than healthy women (OR=2.96; 95% CI, 2.47-3.55) and women with heart disease non-cardiomyopathy (OR=1.9; 95% CI, 1.62-2.22), according to the researchers. Additionally, women with cardiomyopathy were less likely to have a spontaneous vaginal birth than those without known heart disease (OR = 0.28; 95% CI, 0.23-0.36) and those with other forms of heart disease (OR = 0.61; 95% CI, 0.37-1.01), despite current guidance.

“Current guidelines recommend that vaginal birth is appropriate for the majority [of]women with heart disease due to reduced risk of profuse blood loss and avoidance of major surgery,” Eggleton and colleagues wrote.

Left ventricular ejection fraction

The results also showed that left ventricular ejection fraction was significantly lower in women with cardiomyopathy compared to healthy controls – by approximately 25% (mean difference, -25.17; 95% CI, -38 .98 to -11.35) – and it was about 14% lower than in women with other forms of heart disease (mean difference, -14.15; 95% CI, -16.7 to – 11.59).

MACE results

The researchers found that a composite MACE result was more common in women with cardiomyopathy than in healthy women (OR=206.64; 95% CI, 192.09-222.28) and women with non-cardiomyopathy heart disease (OR = 7.09; 95% CI, 6.08-8.27).

In-hospital mortality was significantly more common in women with cardiomyopathy than in those without known heart disease (OR = 126.67; 95% CI, 43.01-373.07). They were also more likely to die in hospital than those with heart disease other than cardiomyopathy (OR=4.3; 95% CI, 3.42-5.4), which Eggleton et al. his colleagues, was a “major concern”.

Individual MACE analyzes showed that women with cardiomyopathy were more likely to experience cardiac arrest, heart failure, myocardial infarction, arrhythmia, pulmonary embolism, anesthesia complications, and cardiorespiratory or respiratory failure during pregnancy. pregnancy. However, the risk of cerebrovascular events was higher in women with cardiomyopathy than in healthy women, but not compared to women with other heart diseases, and there was no difference in the rate of aortic dissection between groups.

Non-MACE results

Admission rates to an intensive therapy unit among women with cardiomyopathy and healthy controls were reported in one study, which showed that women with cardiomyopathy were significantly more likely to be admitted (OR = 12, 22; 95% CI, 2.51-59.51). In four studies comparing the admission rate between women with cardiomyopathy and other forms of heart disease, those with cardiomyopathy were more likely to be admitted (OR = 4.02; 95% CI, 1.57 -10.32).

Additionally, women with cardiomyopathy were more likely to be readmitted within 30 days and stay longer postpartum compared to the two control groups.

In the future, Eggleton and colleagues suggested that large international studies examine rates of adverse maternal outcomes by cardiomyopathy subtype to strengthen their findings.


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