Rebecca Man, Jack Le Vance, Hafsa Abdullahi, Clare Davenport, Mengshi Yuan, Laura Ormesher, Sana Usman, James Castleman, Caroline Fox, Lucy Hudsmith, R. Katie Morris, Victoria Hodgetts Morton
{"title":"Maternal and fetal outcomes in subsequent pregnancies after peripartum cardiomyopathy: A systematic review and meta-analysis","authors":"Rebecca Man, Jack Le Vance, Hafsa Abdullahi, Clare Davenport, Mengshi Yuan, Laura Ormesher, Sana Usman, James Castleman, Caroline Fox, Lucy Hudsmith, R. Katie Morris, Victoria Hodgetts Morton","doi":"10.1111/aogs.15117","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>We aim to determine the pregnancy and cardiovascular outcomes of subsequent pregnancies following a previous diagnosis of peripartum cardiomyopathy.</p>\n </section>\n \n <section>\n \n <h3> Material and Methods</h3>\n \n <p>Medline, Embase, CINAHL, and Web of Science were searched from inception to November 2023. Primary research studies of any design providing data for any of our outcomes of interest with greater than five subsequent pregnancies were eligible for inclusion. Primary outcomes included relapse of cardiac failure in the first subsequent pregnancy and death during any subsequent pregnancy. Secondary outcomes included a range of maternal and fetal outcomes. Proportional meta-analysis, applying a random effects model, was performed using R software.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Twenty-nine studies involving 779 women were included, performed across 13 countries. The risk of relapse of cardiac failure in the first subsequent pregnancy (20 studies, 376 women) was 32%, 95% confidence interval [CI] 0.23–0.43. In those with recovered (11 studies, 123 pregnancies) and non-recovered (10 studies, 55 pregnancies) cardiac function at subsequent pregnancy outset, the risk of cardiac failure relapse was 24%, 95% CI 0.16–0.35 and 36%, 95% CI 0.24–0.50, respectively. There was a high chance of preterm birth <37 weeks (12 studies, 212 pregnancies) at 22%, 95% CI 0.17–0.29.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Subsequent pregnancy after peripartum cardiomyopathy presents significant maternal and fetal risks. This study provides quantification of risks to begin to fill the current evidence gap, however is limited by the paucity of existing primary research investigating this population. Robust observational studies of current practice are needed to provide answers in specific populations.</p>\n </section>\n </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1009-1025"},"PeriodicalIF":3.5000,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15117","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Obstetricia et Gynecologica Scandinavica","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/aogs.15117","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
We aim to determine the pregnancy and cardiovascular outcomes of subsequent pregnancies following a previous diagnosis of peripartum cardiomyopathy.
Material and Methods
Medline, Embase, CINAHL, and Web of Science were searched from inception to November 2023. Primary research studies of any design providing data for any of our outcomes of interest with greater than five subsequent pregnancies were eligible for inclusion. Primary outcomes included relapse of cardiac failure in the first subsequent pregnancy and death during any subsequent pregnancy. Secondary outcomes included a range of maternal and fetal outcomes. Proportional meta-analysis, applying a random effects model, was performed using R software.
Results
Twenty-nine studies involving 779 women were included, performed across 13 countries. The risk of relapse of cardiac failure in the first subsequent pregnancy (20 studies, 376 women) was 32%, 95% confidence interval [CI] 0.23–0.43. In those with recovered (11 studies, 123 pregnancies) and non-recovered (10 studies, 55 pregnancies) cardiac function at subsequent pregnancy outset, the risk of cardiac failure relapse was 24%, 95% CI 0.16–0.35 and 36%, 95% CI 0.24–0.50, respectively. There was a high chance of preterm birth <37 weeks (12 studies, 212 pregnancies) at 22%, 95% CI 0.17–0.29.
Conclusions
Subsequent pregnancy after peripartum cardiomyopathy presents significant maternal and fetal risks. This study provides quantification of risks to begin to fill the current evidence gap, however is limited by the paucity of existing primary research investigating this population. Robust observational studies of current practice are needed to provide answers in specific populations.
简介:我们的目的是确定妊娠和心血管预后的后续妊娠后,先前诊断围产期心肌病。材料和方法:检索自成立至2023年11月的Medline、Embase、CINAHL和Web of Science。为我们感兴趣的任何结果提供数据且超过5次妊娠的任何设计的初步研究均符合纳入条件。主要结局包括第一次妊娠心衰复发和随后任何妊娠死亡。次要结局包括一系列母体和胎儿结局。采用R软件进行比例荟萃分析,采用随机效应模型。结果:29项研究涉及779名妇女,在13个国家进行。在随后的第一次妊娠中(20项研究,376名妇女)心力衰竭复发的风险为32%,95%可信区间[CI] 0.23-0.43。在随后的妊娠开始时心功能恢复(11项研究,123例妊娠)和未恢复(10项研究,55例妊娠)的患者中,心力衰竭复发的风险分别为24% (95% CI 0.16-0.35)和36% (95% CI 0.24-0.50)。结论:围产期心肌病后再次妊娠存在显著的母胎风险。本研究提供了风险的量化,开始填补目前的证据空白,但由于缺乏现有的主要研究调查这一人群。需要对当前实践进行强有力的观察性研究,以在特定人群中提供答案。
期刊介绍:
Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.