Pregnancy outcomes in women with significant valve disease: a systematic review and meta-analysis

Abstract

ObjectiveTo perform a systematic review and meta-analysis of maternal/fetal outcomes in pregnant women with moderate/severe native valvular heart disease (VHD) from medium/higher Human Development Index (HDI) countries.MethodsOvidSP platform databases were searched (1985-January 2019) to identify studies reporting pregnancy outcomes in women with moderate/severe VHD. The primary maternal outcome was maternal mortality. The primary fetal/neonatal outcome was stillbirth and neonatal death. Pooled incidences and 95% confidence intervals (CI) of maternal/fetal outcomes could only be calculated from studies involving mitral stenosis (MS) or aortic stenosis (AS).ResultsTwelve studies on 646 pregnancies were included. Pregnant women with severe MS had mortality rates of 3% (95% CI, 0% to 6%), pulmonary oedema 37% (23%–51%) and new/recurrent arrhythmias 16% (1%–25%). Their stillbirth, neonatal death and preterm birth rates were 4% (1%–7%), 2% (0%–4%), and 18% (7%–29%), respectively. Women with moderate MS had mortality rates of 1%(0%–2%), pulmonary oedema 18% (2%–33%), new/recurrent arrhythmias 5% (1%–9%), stillbirth 2% (1%–4%) and preterm birth 10%(2%–17%).Pregnant women with severe AS had a risk of mortality of 2% (0%–5%), pulmonary oedema 9% (2%–15%), and new/recurrent arrhythmias 4% (0%–7%). Their stillbirth, neonatal death and preterm birth rates were 2% (0%–5%), 3% (0%–6%) and 14%(4%–24%), respectively. No maternal/neonatal deaths were reported in moderate AS, however women experienced pulmonary oedema (8%; 0%–20%), new/recurrent arrhythmias (2%; 0%–5%), and preterm birth (13%; 6%–20%).ConclusionsWomen with moderate/severe MS and AS are at risk for adverse maternal and fetal/neonatal outcomes. They should receive preconception counseling and pregnancy care by teams with pregnancy and heart disease experience.

Percutaneous balloon mitral valvotomy during pregnancy: A systematic review and meta‐analysis

“…PBMV done in the second trimester, well before the peak of hemodynamic changes in pregnancy (around 32 weeks), may help by increasing area and reducing pressure gradients. Compared with the high mortality rates (6%‐10%) reported among the pregnant women with untreated MS, 39,40 the pooled estimates of 0.01% (0.0‐0.76) suggest an improvement in tolerance to hemodynamic changes following PBMV, optimizing the maternal outcomes.…”

“…Hemodynamic changes in pregnancy pose a risk to pregnant women with MS, especially those with NYHA class 3 or 4, increasing the risk of mortality to 6%-10%. 39,40 . PBMV opens the mitral valve, with a resultant reduction in transmitral gradient and left atrial pressure (Table 1), thereby decreasing the risk of pulmonary edema.…”

Vaginal delivery in a patient with severe aortic stenosis under epidural analgesia, a case report

“…Pregnancy is generally well tolerated in patients with moderate or severe asymptomatic aortic stenosis, whereas symptomatic severe stenosis patients are more likely to require hospitalization. The most common complications are: heart failure, pulmonary edema, and arrhythmias [ 15 , 16 ]. Despite the severity of our patient’s stenosis, she was asymptomatic before conception and maintained a good functional status throughout the pregnancy.…”

Pregnancy in women with valvular heart disease: a call to action to reduce morbidity and mortality in both mother and child

“…In this issue, Ducas and colleagues attempt to clarify both the maternal and fetal outcomes of pregnancies in women with significant VHD from countries with medium or higher HDI by performing a systemic review and meta-analysis 4. Sufficiently robust data to assess both maternal and fetal outcomes were found only for women with mitral stenosis (MS) and aortic stenosis (AS).…”