Cardiomyopathy increases risk for adverse perinatal outcomes

Women with cardiomyopathy were more likely to experience adverse outcomes such as stillbirth compared with women who had noncardiomyopathy cardiac disease or no cardiac disease, according to a systematic review and meta-analysis.

“Several studies suggest that pregnancies complicated by maternal cardiomyopathy are at increased risk of adverse perinatal outcomes, including prematurity, low birth weight and small for gestational age,” Elizabeth J. Eggleton, BSc, MSc, a trainee cardiac scientist at the Newcastle University Medical School in Newcastle upon Tyne, England, and colleagues wrote in the American Journal of Obstetrics & Gynecology. “These outcomes are associated with short-term perinatal morbidity and mortality and also with long-term adverse health outcomes for infants, including cardiovascular and metabolic disease.”

Eggleton and colleagues identified all observational cohort, case-control and case-cohort studies that reported perinatal outcomes among pregnant women with any subtype of cardiomyopathy and among a control group — either women with a different cardiac disease or no known cardiac disease. Women with no cardiac disease were termed “healthy.”

The 13 eligible studies comprised 2,291,024 pregnancies in the United States, the United Kingdom, Brazil, Japan and China, and most (n = 8 studies) had a low or moderate risk for bias.

Likelihood of stillbirth, mortality, preterm birth

According to the study, women with cardiomyopathy were more likely to experience stillbirth (OR = 20.82; 95% CI, 6.68-64.95) or neonatal mortality (OR = 6.75; 95% CI, 3.54-12.89) compared with healthy women. They were also more likely than women with noncardiomyopathy cardiac disease to experience those outcomes (stillbirth, OR = 3.75; 95% CI, 1.86-7.59; neonatal mortality, OR = 2.42; 95% CI, 1.39-4.21).

Women with cardiomyopathy were also more likely to have a preterm delivery compared with healthy women (OR = 5.95; 95% CI, 5.01-7.07) and women with noncardiomyopathy cardiac disease (OR = 2.21; 95% CI, 1.31-3.73).

Neonatal outcomes

Infants were more likely to be born small for gestational age in pregnancies complicated by cardiomyopathy compared with healthy pregnancies (OR = 6.74; 95% CI, 5.32-7.86) and compared with pregnancies complicated by a different cardiac disease (OR = 2.97; 95% CI, 2.39-3.7).

These infants were also more likely to have a low birth weight compared with infants born to healthy women (OR = 5.37; 95% CI, 4.55-6.33) and to women with other cardiac disease (OR = 2.48; 95% CI, 2.02-3.04), and were more likely to be admitted to the NICU compared with their counterparts (OR = 2.74; 95% CI, 1.2-6.26; and OR = 2.95; 95% CI, 1.28-6.82, respectively).

“Our results should help to inform such counselling and to improve multidisciplinary clinical management of pregnant women with cardiomyopathy,” Eggleton and colleagues wrote. “Given the high risks involved to both mother and fetus, pregnancies in women with cardiomyopathy should optimally be under the care of expert multidisciplinary teams with the capacity to closely monitor fetal growth and well-being in addition to maternal cardiac status.”