心脏-产科护理对心脏病孕妇产妇结局的影响：系统回顾和荟萃分析

IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology Pub Date : 2025-10-10 DOI:10.1016/j.cpcardiol.2025.103190

Sneha Annie Sebastian MD , Harshan Atwal MD , Tanesh Ayyalu MD , Martha Gulati MD, MS

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引用次数: 0

摘要

背景：在美国，孕产妇死亡率处于历史最高水平，孕产妇心脏病是导致死亡的主要原因。心产科学是一种协作性的、多学科的孕产妇护理方法，汇集了母胎医学、心脏病学和其他专业的专家。本研究探讨了心产团队护理对产妇结局的影响，重点探讨了这种综合模式如何改善患有心血管疾病（CVD）的孕妇的健康和福祉。方法：通过检索MEDLINE、Web of Science、Scopus和Cochrane进行系统综述，检索时间截止到2025年3月5日。采用RevMan 5.4进行统计学分析，采用逆方差随机效应模型计算二分类结果的风险比（RR）。采用Higgins I²检验评估异质性。研究方案已在PROSPERO注册（CRD420251010149）。结果：我们确定了6项评估心产团队护理的观察性研究，包括1109名患有心血管疾病的孕妇，平均年龄为30.8岁。大多数参与者的CARPREG II评分为bb0.2，表明产妇心血管不良结局的风险很高。分娩时的平均胎龄为38周，心律失常是最常见的心血管疾病，其次是先天性和瓣膜性心脏病。合并分析显示，与标准治疗相比，心血管疾病孕妇接受心产护理后30天再入院率有统计学意义的降低（RR 0.29, 95% CI: 0.13-0.64, p = 0.002,I² = 0%），未观察到异质性。产后心律失常发生率也显著降低（RR 0.07, 95% CI: 0.04 ~ 0.12, p < 0.001, I² = 0%）。然而，两组产妇死亡率无显著差异（RR 0.74, 95% CI: 0.14-3.93, p = 0.72,I² = 0%）。结论：与标准护理相比，心产团队护理的CVD孕妇的产妇结局很有希望，表明这种综合护理模式的潜力。这些结果强调需要进一步研究以探索其长期效益。由于缺乏直接比较数据，标准护理数据使用全国平均数据进行近似，在解释结果时应考虑到这一点。总结：心脏病是美国怀孕期间死亡的主要原因。这项研究着眼于由不同专业的医生组成的专门的心脏产科团队是否能改善患有心脏病的孕妇的预后。对1100多名妇女进行的六项研究发现，由这些心脏产科团队护理的妇女在分娩后再入院和心律问题较少，尽管死亡率没有什么不同。

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Impact of cardio-obstetrics care on maternal outcomes in pregnant women with heart disease: A systematic review and meta-analysis

Background

Maternal mortality is at an all-time high in the U.S., with maternal cardiac disease being the leading cause of death. Cardio-obstetrics is a collaborative, multidisciplinary approach to maternal care, bringing together experts from maternal-fetal medicine, cardiology, and other specialties. This study investigates the impact of cardio-obstetrics team care on maternal outcomes, focusing on how this integrated model can improve the health and well-being of pregnant women with cardiovascular disease (CVD).

Methods

We conducted a systematic review by searching MEDLINE, Web of Science, Scopus, and Cochrane up to March 5, 2025. Statistical analysis was performed using RevMan 5.4, with an inverse variance random effects model to calculate risk ratios (RR) for dichotomous outcomes. Heterogeneity was assessed using the Higgins I² test. The study protocol is registered in PROSPERO (CRD420251010149).

Results

We identified six observational studies evaluating cardio-obstetrics team care, including a total of 1,109 pregnant women with CVD, with a mean age of 30.8 years. Most participants had a CARPREG II score > 2, indicating high risk for adverse maternal cardiovascular outcomes. The average gestational age at delivery was 38 weeks, with arrhythmias being the most common cardiovascular condition, followed by congenital and valvular heart disease. Pooled analysis revealed a statistically significant reduction in the 30-day postpartum readmission rate for pregnant women with CVD receiving cardio-obstetrics care compared to standard care (RR 0.29, 95 % CI: 0.13–0.64, p = 0.002, I² = 0 %) with no observed heterogeneity. There was also a significant decrease in postpartum arrhythmias (RR 0.07, 95 % CI: 0.04–0.12, p < 0.001, I² = 0 %). However, no significant difference in maternal mortality was found between the two groups (RR 0.74, 95 % CI: 0.14–3.93, p = 0.72, I² = 0 %).

Conclusion

Maternal outcomes with cardio-obstetrics team care in pregnant women with CVD were promising, indicating the potential of this integrated care model when compared with standard care. These results emphasize the need for further research to explore its long-term benefits. Standard care data were approximated using national averages due to the lack of direct comparison data, which should be considered when interpreting the results.

Lay Summary

Heart disease is the leading cause of death during pregnancy in the U.S. This study looked at whether having a specialized cardio-obstetrics team made up of doctors from different specialties working together improves outcomes for pregnant women with heart disease. Six studies with >1,100 women found that women cared for by these cardio-obstetrics teams had fewer hospital readmissions and fewer heart rhythm problems after delivery, though death rates were not different.

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来源期刊

Current Problems in Cardiology 医学-心血管系统

CiteScore

4.80

自引率

2.40%

发文量

392

审稿时长

6 days

期刊介绍： Under the editorial leadership of noted cardiologist Dr. Hector O. Ventura, Current Problems in Cardiology provides focused, comprehensive coverage of important clinical topics in cardiology. Each monthly issues, addresses a selected clinical problem or condition, including pathophysiology, invasive and noninvasive diagnosis, drug therapy, surgical management, and rehabilitation; or explores the clinical applications of a diagnostic modality or a particular category of drugs. Critical commentary from the distinguished editorial board accompanies each monograph, providing readers with additional insights. An extensive bibliography in each issue saves hours of library research.