A Scoping Review of Clinical Guidelines for the Management of Cardiovascular Diseases (CVD) in Pregnancy in Low- and Middle-Income Countries (LMIC).

IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Global Heart Pub Date : 2025-08-21 eCollection Date: 2025-01-01 DOI:10.5334/gh.1453
Uma Vasudevan, Preety Rajbangshi, Jane Hirst
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引用次数: 0

Abstract

Cardiovascular diseases (CVD), including pre-existing cardiac conditions and hypertensive disorders of pregnancy, are among the leading causes of maternal mortality globally and account for a substantial proportion of preventable deaths in low- and middle-income countries (LMICs). In these settings, women are disproportionately affected by conditions such as rheumatic heart disease, peripartum cardiomyopathy, and severe anemia-related heart failure, yet clinical guidance tailored to LMICs contexts remains limited. This paper presents the findings of a scoping review on CVD in pregnancy guidelines in LMICs. The review seeks to identify and map clinical guidelines from LMICs and international organizations with reach in LMICs that addresses the prevention, screening, and management of cardiovascular diseases (CVD) in pregnancy and examine their scope, content, and specific recommendations for pregnant women. The review followed the JBI methodology. Guidelines on CVD care in pregnancy published between 2011 and 2023 by international or national professional organizations and Ministries of Health from LMICs were searched using databases such as PubMed, Scopus, GIN International library, and individual websites. Data were extracted using a custom-designed MS Excel form, capturing details such as guideline title, year, type, publisher, country, target audience and population, clinical focus, timing, and summary of recommendations. Out of the 90 shortlisted guidelines, 17 were included and 73 were excluded. Of the included guidelines, 3 are on CVDS and 14 are on hypertensive disorders of pregnancy (HDP). They varied in scope, with most focusing on preeclampsia or HDP, but only a few provided comprehensive recommendations across the continuum of cardiovascular care in pregnancy, highlighting major gaps in prevention, screening, and long-term follow-up. Existing guidance remains fragmented with limited coverage of high-burden conditions of LMICs such as rheumatic heart disease. Strengthening clinical practice will require not only adapting global recommendations to local realities but also investing in LMIC-led research and inclusive guideline development that reflects regional priorities and health system capacities.

Abstract Image

中低收入国家(LMIC)妊娠期心血管疾病(CVD)管理临床指南的范围审查
心血管疾病,包括先前存在的心脏病和妊娠高血压疾病,是全球孕产妇死亡的主要原因之一,在低收入和中等收入国家可预防的死亡中占很大比例。在这些情况下,妇女不成比例地受到风湿性心脏病、围产期心肌病和严重贫血相关心力衰竭等疾病的影响,但针对中低收入国家情况的临床指导仍然有限。本文介绍了中低收入国家妊娠指南中心血管疾病的范围审查结果。本综述旨在确定和绘制中低收入国家和国际组织针对妊娠期心血管疾病(CVD)预防、筛查和管理的临床指南,并检查其范围、内容和对孕妇的具体建议。审查遵循JBI方法。使用PubMed、Scopus、GIN国际图书馆和个人网站等数据库检索了2011年至2023年间由国际或国家专业组织和低收入国家卫生部发布的妊娠期心血管疾病护理指南。使用定制设计的MS Excel表格提取数据,获取指南标题、年份、类型、出版商、国家、目标受众和人群、临床重点、时间和建议摘要等详细信息。在90个候选指南中,有17个被纳入,73个被排除。在纳入的指南中,有3个是关于心血管疾病的,14个是关于妊娠高血压疾病的。它们的范围各不相同,大多数侧重于先兆子痫或HDP,但只有少数提供了关于妊娠期心血管护理连续体的综合建议,突出了预防、筛查和长期随访方面的主要差距。现有指南仍然支离破碎,对风湿性心脏病等中低收入国家高负担疾病的覆盖范围有限。加强临床实践不仅需要根据当地实际情况调整全球建议,还需要投资于中低收入国家主导的研究和包容性指南制定,以反映区域优先事项和卫生系统能力。
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来源期刊
Global Heart
Global Heart Medicine-Cardiology and Cardiovascular Medicine
CiteScore
5.70
自引率
5.40%
发文量
77
审稿时长
5 weeks
期刊介绍: Global Heart offers a forum for dialogue and education on research, developments, trends, solutions and public health programs related to the prevention and control of cardiovascular diseases (CVDs) worldwide, with a special focus on low- and middle-income countries (LMICs). Manuscripts should address not only the extent or epidemiology of the problem, but also describe interventions to effectively control and prevent CVDs and the underlying factors. The emphasis should be on approaches applicable in settings with limited resources. Economic evaluations of successful interventions are particularly welcome. We will also consider negative findings if important. While reports of hospital or clinic-based treatments are not excluded, particularly if they have broad implications for cost-effective disease control or prevention, we give priority to papers addressing community-based activities. We encourage submissions on cardiovascular surveillance and health policies, professional education, ethical issues and technological innovations related to prevention. Global Heart is particularly interested in publishing data from updated national or regional demographic health surveys, World Health Organization or Global Burden of Disease data, large clinical disease databases or registries. Systematic reviews or meta-analyses on globally relevant topics are welcome. We will also consider clinical research that has special relevance to LMICs, e.g. using validated instruments to assess health-related quality-of-life in patients from LMICs, innovative diagnostic-therapeutic applications, real-world effectiveness clinical trials, research methods (innovative methodologic papers, with emphasis on low-cost research methods or novel application of methods in low resource settings), and papers pertaining to cardiovascular health promotion and policy (quantitative evaluation of health programs.
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