What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Prosthetic heart valves in pregnancy (n=499). Intervention: Prosthetic heart valves. Primary outcome: Maternal mortality (95% CI 0.5-2.2).

What does this research mean for the field?

Pregnancies in women with prosthetic heart valves have a pooled maternal mortality of 1.2/100 pregnancies, and those with bioprostheses experience significantly fewer thromboembolic events compared to those with mechanical valves. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the risk of adverse maternal, fetal, and neonatal outcomes among pregnant women with prosthetic heart valves over the past two decades.

June 29, 2015BJOG An International Journal of Obstetrics & Gynaecology

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

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Key result

Pregnancies in women with prosthetic heart valves had a pooled maternal mortality of 1.2/100 pregnancies (95% CI 0.5-2.2), with bioprostheses having significantly fewer thromboembolic events.

Why the study?

What is the risk of adverse pregnancy outcomes in women with prosthetic heart valves?

Population

11 studies capturing 499 pregnancies among women with heart valve prostheses

Comparison

Prosthetic heart valves vs General obstetric population and comparison…

Design

Meta-analysis

Follow-up

perinatal period

Authors

CLCM LawleyThe University of Sydney SLSJ LainThe University of Sydney CACharles S. AlgertThe University of Sydney

Discussion

Member takes

Implication

Warrants specialized cardio-obstetric care and bioprosthetic consideration preconception; updates maternal mortality estimates lower than prior reports.

Key Points

To assess the risk of adverse maternal, fetal, and neonatal outcomes among pregnant women with prosthetic heart valves over the past two decades.
Searched Medline, The Cochrane Library, CINAHL, and Embase for trials, cohort studies, and unselected case series involving pregnant women with prosthetic heart valves.
Included 11 studies evaluating 499 pregnancies, comprising 256 mechanical and 59 bioprosthetic valve cases.
Calculated pooled absolute risks using a random-effects model, applying the Freeman-Tukey transformation to account for zero-event outcomes.
Pooled maternal mortality was 1.2 per 100 pregnancies (95% CI 0.5–2.2), with rates of 1.8 per 100 (95% CI 0.5–3.7) in the mechanical valve subgroup and 0.7 per 100 (95% CI 0.1–4.5) in the bioprosthetic subgroup.
Overall pregnancy loss occurred at a rate of 20.8 per 100 pregnancies (95% CI 9.5–35.1), perinatal mortality was 5.0 per 100 births (95% CI 1.8–9.8), and thromboembolism occurred in 9.3 per 100 pregnancies (95% CI 4.0–16.5).

Study Design

Type

Meta-Analysis (n=499)

Structured PICO

What is the risk of adverse pregnancy outcomes in women with prosthetic heart valves?

Population

11 studies capturing 499 pregnancies among women with heart valve prostheses (256 mechanical and 59 bioprosthetic)

Intervention

Prosthetic heart valves (mechanical or bioprosthetic)

Comparator

General obstetric population (expected rates) and comparison between bioprosthetic vs mechanical valves

Outcome

Adverse pregnancy outcomes including maternal mortality, pregnancy loss, perinatal mortality, and thromboembolismhard clinical

Women with prosthetic heart valves have higher rates of adverse pregnancy outcomes than the general population, though lower than previously reported, with bioprostheses showing fewer thromboembolic events than mechanical valves.

Cite This Study

Lawley et al. (2015) conducted a meta-analysis in Prosthetic heart valves in pregnancy (n=499). Prosthetic heart valves was evaluated on Maternal mortality (95% CI 0.5-2.2). Pregnancies in women with prosthetic heart valves had a pooled maternal mortality of 1.2/100 pregnancies (95% CI 0.5-2.2), with bioprostheses having significantly fewer thromboembolic events.

synapsesocial.com/papers/6a142e2a40803be22f8942fd https://doi.org/10.1111/1471-0528.13491

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Implication

Warrants specialized cardio-obstetric care and bioprosthetic consideration preconception; updates maternal mortality estimates lower than prior reports.

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

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

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

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Also Consider