The frequency and outcomes of maternal cardiac disease in

high-resource settings: a systematic review and meta-analysis

Ling Tao1, Anshu Ramaiya2, Rema Ramakrishnan1, Oliver Rivero-Arias1, Joris Hemelaar1, Marian Knight1

1National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK; 2 Medical Sciences Division, University of Oxford, UK

 

Purpose

Many studies in high-resource settings have identified cardiac disease as a leading

cause of maternal deaths [1–3], with recent large-scale data showing a 25% increase

in its prevalence [4]. However, the burden of maternal cardiac disease in high-

resource settings has not been accurately assessed. This study aimed to estimate

the frequency and outcomes of maternal cardiac disease and its subtypes in high-

resource settings.

 

Methods

A systematic review was conducted by searching MEDLINE, Embase, CINAHL, and

Google Scholar for studies on maternal cardiac disease in high-resource settings.

Random-effects meta-analyses were performed, and heterogeneity was assessed.

Inclusion

criteria:

 Population-based

 2013-2023

 Journal articles, reports, grey literature

Population: Women during or up to six weeks after pregnancy

in high-resource settings

Outcomes: Prevalence, incidence, and mortality of cardiac disease

Studies screened (n = 4147)

Studies assessed for eligibility (n = 285)

Studies included in review (n = 84)

Data extraction

Risk of bias assessment

Meta-analyses

Publication bias assessment

 

Results

The systematic review identified 84 studies. The pooled prevalence of overall cardiac

disease was 0.54% [95% confidence interval (CI) 0.26%-4.95%, I2=99.5%] (Fig A).

The pooled maternal mortality due to cardiac disease was 2 per 100,000 women

giving birth (95% CI 2-3 per 100,000, I2=85%) (Fig B).

The most prevalent cardiac disease subtypes were arrhythmias [0.68% (95%CI

0.30%-2.84%), I2=99.5%], congenital heart disease [0.21% (95%CI 0.15%-0.57%),

I2=98.9%], and valvular heart disease [0.16% (95%CI 0.12%-2.12%), I2=99.9%].

High heterogeneity was the main limitation with different disease definitions and data

sources being key sources of variation. 80% of the included data sets came from the

United States of America and United Kingdom, limiting the representativeness of the

findings for other high-resource settings.

 

Conclusions

•Estimates of the prevalence, incidence, and mortality of maternal cardiac disease

and subtypes are available for high-resource settings, although estimates vary

between studies, making the true burden uncertain. Further research using

consistent disease definitions and comparable data sources is needed.

•Furthermore, data from a greater diversity of high-income countries are needed.

 

Reference:

[1] Kallianidis AF, Schutte JM, Schuringa LEM, Beenakkers ICM, Bloemenkamp KWM, Braams-Lisman BAM,

et al. Acta Obstetricia et Gynecologica Scandinavica 2022;101:441-449. doi: https://doi.org/https://dx.doi.

org/10.1111/aogs.14312

[2] Syeda SK, Wen T, Wright JD, Goffman D, D’Alton ME, Friedman AM. Journal of Maternal-Fetal and Neonatal

Medicine 2022;35:4768-4774. doi: https://doi.org/https://dx.doi.org/10.1080/14767058.2020.1863368

[3] Felker A, Knight M, Patel R, Kotnis R, Kenyon S. In. Oxford: National Perinatal Epidemiology Unit, University

of Oxford; 2024.

[4] Owens A, Yang J, Nie L, Lima F, Avila C, Stergiopoulos K. Journal of the American Heart

Funding:

M.K. is a Senior Investigator of National Institute for Health and Care Research (NIHR). L.T. is the recipient of

China Scholarship Council- Chinese Academy of Medical Sciences Oxford Institute MD/PhD Scholarship. R.R.

is supported by the Oxford NIHR Biomedical Research Centre.