Pregnant women with cardiomyopathy at increased risk of maternal mortality: AJOG

UK: A new article published in the American Journal of Obstetrics and Gynecology suggests that pregnant women with cardiomyopathy had much higher chances of advers maternal outcomes, including maternal mortality.

Cardiomyopathy is a condition marked by structural and functional impairments of the ventricular myocardium in absence of any disorders causing cardiac abnormalities. The International Registry of Pregnancy and Cardiac Disease (ROPAC) study discovered that heart failure, maternal mortality, and ventricular arrhythmias occurred more frequently in women with cardiomyopathy than in women with other types of heart disease, emphasizing the importance of close monitoring of pregnant women with cardiomyopathy. Pregnancy and delivery treatment in women with cardiomyopathy is a challenging clinical problem that is exacerbated by a present lack of rigorous research to determine optimum management techniques.

Against the above background, Elizabeth J. EGGLETON and colleagues carried out this research to comprehensively analyze the influence of cardiomyopathy on mother pregnancy outcomes.

From conception until April 24th, 2022, PubMed, Ovid EMBASE, Ovid Medline, Cochrane Library, and clinicaltrials.gov were thoroughly searched. Observational cohort, case-control, and case-cohort studies in human populations that reported pre-defined maternal outcomes in pregnant women with cardiomyopathy (any subtype) and an adequate control group were considered. A third reviewer addressed issues after two reviewers independently assessed papers for eligibility and bias risk. PRISMA/MOOSE criteria were used to extract and synthesize data.

The key findings of this study were as follows:

1. 14 studies (57,539,306 pregnancies) met the inclusion criteria.

2. Women with cardiomyopathy were more likely to have a cesarean section than women without heart disease or with heart illness that was not cardiomyopathy.

3. Cardiomyopathy increased the risk of severe maternal adverse cardiovascular events throughout pregnancy compared to women with no heart disease or non-cardiomyopathy heart disease.

4. Women with cardiomyopathy had considerably greater in-hospital mortality than women without heart disease or women with non-cardiomyopathy heart illness.

In conclusion, this study's findings emphasize the necessity of pre-conception risk assessments in allowing for informed decision-making prior to pregnancy. Cardiomyopathy-affected pregnancies are high risk and should be handled by skilled multidisciplinary obstetric and cardiology teams.

Reference:

EGGLETON, E. J., MCMURRUGH, K. J., & AIKEN, C. E. (2022). Maternal pregnancy outcomes in women with cardiomyopathy: A systematic review and meta-analysis. In American Journal of Obstetrics and Gynecology. Elsevier BV. https://doi.org/10.1016/j.ajog.2022.05.039