Maternal cardiomyopathy linked to adverse perinatal outcomes

Pregnancies complicated by maternal cardiomyopathy are at risk of adverse perinatal outcomes, according to a systematic review and meta-analysis.

Researchers searched multiple online databases for observational cohort, case-control, and case-cohort studies that evaluated predefined perinatal outcomes in pregnant women with cardiomyopathy (any subtype) and a corresponding control population (either pregnant women with no known cardiac disease or pregnant women with noncardiomyopathy cardiac disease).

The studies were assessed for eligibility and risk of bias, with data extracted and synthesized according to PRISMA/MOOSE guidelines.

A total of 13 studies involving 2,291,024 pregnancies were included in the analysis. The frequency of perinatal death was higher among neonates born to women with cardiomyopathy than among those born to women with no cardiac disease (stillbirth: odds ratio [OR], 20.82, 95 percent confidence interval [CI], 6.68–64.95; I2, NA%; p<0.00001; neonatal mortality: OR, 6.75, 95 percent CI, 3.54–12.89; I2=0%; p<0.00001) and women with other forms of cardiac disease (stillbirth: OR, 3.75, 95 percent CI, 1.86–7.59; I2=0%; p=0.0002; neonatal mortality: OR, 2.42, 95 percent CI, 1.39–4.21; I2=0%; p=0.002).

Compared to other forms of cardiac disease, the presence of maternal cardiomyopathy during pregnancy was associated with a higher likelihood of preterm birth (OR, 2.21, 95 percent CI, 1.31–3.73; I2=77%; p=0.003) and small-for-gestational age neonates (OR, 2.97, 95 percent CI, 2.38–3.70; I2=47%; p<0.00001). Both outcomes were said to be major causes of short- and long-term morbidity.

The findings highlight the importance that women with cardiomyopathy who embark on pregnancy receive detailed counselling regarding the risk of adverse perinatal outcomes and have their pregnancies managed by experienced multidisciplinary teams that can provide close foetal monitoring and neonatology expertise.