Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis.

Joshua Liaw,Andrew V. White,Leanne Hall,Betrice Walker,Susan Gorton,Clare Heal

doi:10.1371/journal.pone.0253581

Joshua Liaw, Andrew V. White + Show 4 more

Open Access

https://doi.org/10.1371/journal.pone.0253581

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Journal: PloS one	Publication Date: Jun 29, 2021
Citations: 6	License type: CC BY 4.0

Affiliation: James Cook University

Abstract

PurposeAssociations 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.MethodsMedline (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).FindingsThe 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).InterpretationRHD during pregnancy is associated with adverse fetal outcomes. Maternal NYHA III/IV and moderate/severe MS in particular may predict poor prognosis.

Highlights

The global prevalence of rheumatic heart disease (RHD) is 1%, and is twice as common in women than men, in women of childbearing age [1, 2]
The studies, published from 1990–2020, comprising 3928 pregnancies with rheumatic heart disease were conducted across countries including India (7), Israel (2), South Africa (2), Nepal (2), Egypt (2), Canada (1), Australia (3), Brazil (1), Thailand (1)
Results from this review regarding risk index of New-York Heart Association (NYHA) and Mitral-valve Area (MVA) should be interpreted in terms of absolute risk, and metaanalysis is of unadjusted rates

Summary

Introduction

The global prevalence of rheumatic heart disease (RHD) is 1%, and is twice as common in women than men, in women of childbearing age [1, 2]. This figure is likely underestimated in developing countries [2]. The placental-fetal heart circulation is likely affected [10], and hemodynamic insufficiency poses a risk to the developing fetus. Complications such as intrauterine growth restriction (IUGR) and prematurity may have lasting developmental effects into childhood and beyond [11]

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