Outcomes of subsequent pregnancy in women with peripartum cardiomyopathy: a systematic review and meta-analysis

IF 2.8 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Open Heart Pub Date : 2024-04-01 DOI:10.1136/openhrt-2024-002626

Matthew Aldo Wijayanto, Risalina Myrtha, Graciella Angelica Lukas, Annisa Aghnia Rahma, Shafira Nur Hanifa, Hadiqa Almas Zahira, Muhana Fawwazy Ilyas

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引用次数: 0

Abstract

Introduction The primary concern for women who have experienced peripartum cardiomyopathy (PPCM) is the safety of a subsequent pregnancy (SSP). To maximie decision-making, facilitate effective patient counselling, and ultimately improve maternal and fetal outcomes as a whole, it is critical to comprehend the outcomes of SSP in women who have previously experienced PPCM. This study aimed to evaluate the outcomes of SSP in women with PPCM. Methods Three databases (PubMed, Scopus, and ScienceDirect) were used to identify relevant studies prior to 17 October 2023. A total of 662 studies were reviewed. Following the abstract and full-text screenings, 18 observational studies were included, out of which 2 were deemed suitable for inclusion in this meta-analysis. The quality assessment was conducted using the Newcastle-Ottawa Scale. Results This study has a total of 487 SSPs. Although recovered left ventricular (LV) function before entering SSP has the potential to be a beneficial prognostic factor, recovered LV function still has a substantial risk of relapse. The mortality rate of PPCM in an SSP ranged from 0% to 55.5%. Persistent LV dysfunction was significantly associated with an increased mortality rate (OR 13.17; 95% CI 1.54 to 112.28; p=0.02) and lower LV ejection fraction (MD −12.88; 95% CI −21.67 to −4.09; p=0.004). Diastolic and right ventricular functions remained unchanged before SSP and at follow-up. The majority of the SSP was observed alongside hypertension, while pre-eclampsia emerged as the predominant hypertensive complication in most studies. Conclusion SSP increases the risk of relapse and mortality in women with a previous history of PPCM. Persistent LV dysfunction prior to the SSP has a higher mortality risk compared with recovered LV function. SSP was also associated with the worsening of LV echocardiography parameters. All data relevant to the study are included in the article or uploaded as online supplemental information.

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围产期心肌病妇女的后续妊娠结局：系统回顾和荟萃分析

引言曾患围产期心肌病 (PPCM) 的妇女最关心的问题是再次妊娠 (SSP) 的安全性。为了最大限度地帮助患者做出决策，为患者提供有效的咨询，并最终改善孕产妇和胎儿的整体预后，了解曾经历过 PPCM 的妇女的 SSP 预后至关重要。本研究旨在评估 SSP 对 PPCM 患者的治疗效果。方法使用三个数据库（PubMed、Scopus 和 ScienceDirect）查找 2023 年 10 月 17 日之前的相关研究。共查阅了 662 项研究。经过摘要和全文筛选，共纳入 18 项观察性研究，其中 2 项被认为适合纳入本荟萃分析。研究采用纽卡斯尔-渥太华量表进行质量评估。结果本研究共有 487 个 SSP。虽然进入 SSP 前左心室（LV）功能的恢复可能是一个有利的预后因素，但恢复后的左心室功能仍有很大的复发风险。在 SSP 中，PPCM 的死亡率从 0% 到 55.5% 不等。持续的左心室功能障碍与死亡率增加（OR 13.17；95% CI 1.54 至 112.28；P=0.02）和左心室射血分数降低（MD -12.88；95% CI -21.67 至 -4.09；P=0.004）显著相关。舒张功能和右心室功能在 SSP 前和随访时保持不变。大多数 SSP 与高血压同时发生，而在大多数研究中，先兆子痫是主要的高血压并发症。结论 SSP 会增加既往有 PPCM 病史的妇女的复发和死亡风险。与已恢复的左心室功能相比，SSP 前持续存在的左心室功能障碍具有更高的死亡风险。SSP 还与左心室超声心动图参数恶化有关。该研究的所有相关数据均包含在文章中或作为在线补充信息上传。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Open Heart CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.60

自引率

3.70%

发文量

145

审稿时长

20 weeks

期刊介绍： Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.