Objective

This study aimed to systematically assess perinatal outcomes of pregnancies complicated by maternal cardiomyopathy.

Data Sources

PubMed, Ovid Embase, Ovid MEDLINE, the Cochrane Library, and ClinicalTrials.gov were systematically searched from inception to August 25, 2022.

Study Eligibility Criteria

Observational cohort, case-control, and case-cohort studies in human populations were included if they reported predefined perinatal outcomes in pregnant women with cardiomyopathy (any subtype) and an appropriate control population (either pregnant women with no known cardiac disease or pregnant women with noncardiomyopathy cardiac disease).

Methods

Of note, 2 reviewers independently assessed the articles for eligibility and risk of bias, and conflicts were resolved by a third reviewer. Data were extracted and synthesized according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines.

Results

Here, 13 studies (representing 2,291,024 pregnancies) were eligible for inclusion. Perinatal death was more likely in neonates born to women with cardiomyopathy than in (1) neonates born to women with no cardiac disease (stillbirth: odds ratio, 20.82; 95% confidence interval, 6.68–64.95; I² = not available; P<.00001; neonatal mortality: odds ratio, 6.75; 95% confidence interval, 3.54–12.89; I²=0%; P<.00001) and (2) neonates born to women with other forms of cardiac disease (stillbirth: odds ratio, 3.75; 95% confidence interval, 1.86–7.59; I²=0%; P=.0002; neonatal mortality: odds ratio, 2.42; 95% confidence interval, 1.39–4.21; I²=0%; P=.002). Pregnancies affected by maternal cardiomyopathy were significantly more likely to result in preterm birth (odds ratio, 2.21; 95% confidence interval, 1.31–3.73; I²=77%; P=.003) and small-for-gestational-age neonates (odds ratio, 2.97; 95% confidence interval, 2.38–3.70; I²=47%; P<.00001), both major causes of short- and long-term morbidities, than pregnancies affected by other forms of cardiac disease.

Conclusion

There was an increased likelihood of adverse perinatal outcomes in pregnancies affected by maternal cardiomyopathy compared with both pregnancies affected by noncardiomyopathy cardiac disease and pregnancies without cardiac disease. Women with cardiomyopathy who plan to get pregnant should receive detailed counseling regarding these risks and have their pregnancies managed by experienced multidisciplinary teams that can provide close fetal monitoring and neonatology expertise.

中文翻译：

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妊娠合并母体心肌病的围产期结局：系统评价和荟萃分析

客观的

本研究旨在系统评估妊娠并发母体心肌病的围产期结局。

数据源

对 PubMed、Ovid Embase、Ovid MEDLINE、Cochrane 图书馆和ClinicalTrials.gov从开始到 2022 年 8 月 25 日进行了系统搜索。

学习资格标准

如果人群中的观察队列、病例对照和病例队列研究报告了患有心肌病（任何亚型）的孕妇和适当的对照人群（没有已知心脏病的孕妇或患有心脏病的孕妇）的预定义围产期结局非心肌病心脏病）。

方法

值得注意的是，2 位审稿人独立评估了文章的资格和偏倚风险，冲突由第三位审稿人解决。根据系统评价和荟萃分析的首选报告项目和流行病学观察研究的荟萃分析指南提取和合成数据。

结果

在这里，有 13 项研究（代表 2,291,024 次怀孕）符合纳入条件。与 (1) 没有心脏病的妇女所生的新生儿相比，患有心肌病的妇女所生的新生儿围产期死亡的可能性更大（死产：比值比，20.82；95% 置信区间，6.68–64.95；I 2 =不可^用 ；P < .00001；新生儿死亡率：比值比，6.75；95% 置信区间，3.54–12.89；I ² =0%；P <.00001）和 (2) 患有其他形式心脏病的妇女所生的新生儿（死产：比值比, 3.75；95% 置信区间，1.86–7.59；I ² =0%；P =.0002；新生儿死亡率：比值比，2.42；95% 置信区间，1.39–4.21；I² = 0%；P =.002）。受母体心肌病影响的妊娠更可能导致早产（比值比，2.21；95% 置信区间，1.31–3.73； I ² =77%； P =.003）和小于胎龄儿（比值比，2.97；95% 置信区间，2.38–3.70； I ² =47%； P <.00001)，两者都是短期和长期发病率的主要原因，而不是受其他形式心脏病影响的妊娠。

结论

与受非心肌病心脏病和无心脏病影响的妊娠相比，受母体心肌病影响的妊娠发生围产期不良结局的可能性增加。计划怀孕的心肌病女性应接受有关这些风险的详细咨询，并由经验丰富的多学科团队管理她们的妊娠，这些团队可以提供密切的胎儿监测和新生儿学专业知识。