Pregnancy with heart disease in South Asia: A systematic review and meta-analysis of prevalence and outcome

BACKGROUND: The prevalence and paradigm of antenatal heart disease are contrasting between high-income, industrialized, and low- and middle-income countries. In this systematic review, we report the prevalence of heart disease and its spectrum in pregnant women of South Asia. METHODS: We searched through different electronic databases (PubMed, Google-scholar, Embase, Cochrane Library) to locate relevant articles. Studies with sufficient data that met our inclusion criteria were included. Two reviewers independently screened the articles. Discrepancies were resolved by other reviewers. Subsequently, data extraction was done using a standardized form and quality assessment of studies using the Joanna Briggs Institute tool. Meta-analysis was done using R software. RESULTS: After various stages of screening 25 studies were included in the final quantitative synthesis. The pooled prevalence of heart disease among pregnant women was 1.46% (95% CI 0.99–2.01). Among those with heart disease, 70.25% (95% CI 64.87–75.38) had Rheumatic heart disease and 18.10% (95% CI 14.39–22.12) had congenital heart disease. The pooled prevalence of preterm labor and delivery among pregnant women with heart disease was 17.63% (95% CI 12.18–23.80). Similarly, the pooled maternal and fetal mortality rates were 26.14 (95% CI 12.47–43.55) and 50.48 (95% CI 29.59–75.83) per 1000 pregnant women with heart disease respectively. CONCLUSION: As pregnancy, itself is a prolonged state of physiologic stress, heart disease further adds to the risk both for the mother and fetus. Having such a high prevalence, efforts must be made to detect and closely monitor the condition antenatally, and decisions should be made according to the clinical conditions of the patient.