Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis.

<h4>Purpose</h4>Associations between rheumatic heart disease (RHD) in pregnancy and fetal outcomes are relatively unknown. This study aimed to review rates and predictors of major adverse fetal outcomes of RHD in pregnancy.<h4>Methods</h4>Medline (Ovid), Pubmed, EMcare, Scopu...

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Autores principales:	Joshua Liaw, Betrice Walker, Leanne Hall, Susan Gorton, Andrew V White, Clare Heal
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/9fd7c23465e94d45b4b964dc9532b90e
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spelling	oai:doaj.org-article:9fd7c23465e94d45b4b964dc9532b90e2021-12-02T20:09:52ZRheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis.1932-620310.1371/journal.pone.0253581https://doaj.org/article/9fd7c23465e94d45b4b964dc9532b90e2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0253581https://doaj.org/toc/1932-6203<h4>Purpose</h4>Associations between rheumatic heart disease (RHD) in pregnancy and fetal outcomes are relatively unknown. This study aimed to review rates and predictors of major adverse fetal outcomes of RHD in pregnancy.<h4>Methods</h4>Medline (Ovid), Pubmed, EMcare, Scopus, CINAHL, Informit, and WHOICTRP databases were searched for studies that reported rates of adverse perinatal events in women with RHD during pregnancy. Outcomes included preterm birth, intra-uterine growth restriction (IUGR), low-birth weight (LBW), perinatal death and percutaneous balloon mitral valvuloplasty intervention. Meta-analysis of fetal events by the New-York Heart Association (NYHA) heart failure classification, and the Mitral-valve Area (MVA) severity score was performed with unadjusted random effects models and heterogeneity of risk ratios (RR) was assessed with the I2 statistic. Quality of evidence was evaluated using the GRADE approach. The study was registered in PROSPERO (CRD42020161529).<h4>Findings</h4>The search identified 5949 non-duplicate records of which 136 full-text articles were assessed for eligibility and 22 studies included, 11 studies were eligible for meta-analyses. In 3928 pregnancies, high rates of preterm birth (9.35%-42.97%), LBW (12.98%-39.70%), IUGR (6.76%-22.40%) and perinatal death (0.00%-9.41%) were reported. NYHA III/IV pre-pregnancy was associated with higher rates of preterm birth (5 studies, RR 2.86, 95%CI 1.54-5.33), and perinatal death (6 studies, RR 3.23, 1.92-5.44). Moderate /severe mitral stenosis (MS) was associated with higher rates of preterm birth (3 studies, RR 2.05, 95%CI 1.02-4.11) and IUGR (3 studies, RR 2.46, 95%CI 1.02-5.95).<h4>Interpretation</h4>RHD during pregnancy is associated with adverse fetal outcomes. Maternal NYHA III/IV and moderate/severe MS in particular may predict poor prognosis.Joshua LiawBetrice WalkerLeanne HallSusan GortonAndrew V WhiteClare HealPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0253581 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Joshua Liaw Betrice Walker Leanne Hall Susan Gorton Andrew V White Clare Heal Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis.
description	<h4>Purpose</h4>Associations between rheumatic heart disease (RHD) in pregnancy and fetal outcomes are relatively unknown. This study aimed to review rates and predictors of major adverse fetal outcomes of RHD in pregnancy.<h4>Methods</h4>Medline (Ovid), Pubmed, EMcare, Scopus, CINAHL, Informit, and WHOICTRP databases were searched for studies that reported rates of adverse perinatal events in women with RHD during pregnancy. Outcomes included preterm birth, intra-uterine growth restriction (IUGR), low-birth weight (LBW), perinatal death and percutaneous balloon mitral valvuloplasty intervention. Meta-analysis of fetal events by the New-York Heart Association (NYHA) heart failure classification, and the Mitral-valve Area (MVA) severity score was performed with unadjusted random effects models and heterogeneity of risk ratios (RR) was assessed with the I2 statistic. Quality of evidence was evaluated using the GRADE approach. The study was registered in PROSPERO (CRD42020161529).<h4>Findings</h4>The search identified 5949 non-duplicate records of which 136 full-text articles were assessed for eligibility and 22 studies included, 11 studies were eligible for meta-analyses. In 3928 pregnancies, high rates of preterm birth (9.35%-42.97%), LBW (12.98%-39.70%), IUGR (6.76%-22.40%) and perinatal death (0.00%-9.41%) were reported. NYHA III/IV pre-pregnancy was associated with higher rates of preterm birth (5 studies, RR 2.86, 95%CI 1.54-5.33), and perinatal death (6 studies, RR 3.23, 1.92-5.44). Moderate /severe mitral stenosis (MS) was associated with higher rates of preterm birth (3 studies, RR 2.05, 95%CI 1.02-4.11) and IUGR (3 studies, RR 2.46, 95%CI 1.02-5.95).<h4>Interpretation</h4>RHD during pregnancy is associated with adverse fetal outcomes. Maternal NYHA III/IV and moderate/severe MS in particular may predict poor prognosis.
format	article
author	Joshua Liaw Betrice Walker Leanne Hall Susan Gorton Andrew V White Clare Heal
author_facet	Joshua Liaw Betrice Walker Leanne Hall Susan Gorton Andrew V White Clare Heal
author_sort	Joshua Liaw
title	Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis.
title_short	Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis.
title_full	Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis.
title_fullStr	Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis.
title_full_unstemmed	Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis.
title_sort	rheumatic heart disease in pregnancy and neonatal outcomes: a systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/9fd7c23465e94d45b4b964dc9532b90e
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Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis.

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