Prosthetic heart valves in pregnancy, outcomes for women and their babies: A systematic review and meta-analysis

Abstract

Background Historically, pregnancies among women with prosthetic heart valves have been associated with an increased incidence of adverse outcomes. While there have been advances in prosthetic heart valve design, obstetric and medical care, subsequent impact on incidence of adverse outcomes during pregnancy has not been quantified. Objectives To assess the risk of adverse pregnancy outcomes among women with a prosthetic heart valve(s) in the contemporary setting. Search Strategy Electronic literature search of Medline, The Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Embase to find recent studies. Selection Criteria Studies of pregnant women with heart valve prostheses including trials, cohort studies and unselected case series. Data Collection and Analysis Absolute risks and 95% confidence intervals for pregnancy outcomes were calculated using either a random effects model or the logit transformation of total events and participants (the latter method when multiple studies had event counts of zero). Main Results Eleven studies capturing 499 pregnancies among women with heart valve prostheses were eligible for inclusion. Pooled maternal mortality rate was 0.8/100 pregnancies (95% CI 0.3-2.1), pregnancy loss rate 32.1/100 pregnancies (95% CI 28.1-36.3) and perinatal mortality rate 4.7/100 births (95% CI 2.7-7.9). Conclusions Women with heart valve prostheses experienced higher rates of adverse outcomes then would be expected in a general obstetric population, however lower than previously reported. Multidisciplinary pre-pregnancy counselling and vigilant cardiac and obstetric surveillance throughout the perinatal period remains warranted for these women and their infants