Fetal and maternal adverse cardiac outcomes in rheumatic diseases: A systematic review

Autoimmune rheumatic disorders (ARDs) are complex diseases; when experienced during pregnancy, they can be more difficult to manage. Complications vary in severity depending on different factors, including the disease stage and course of treatment.

A comprehensive electronic search with relevant key words was conducted on PubMed, Scopus, CINAHL, Web of Science, Science Direct, and Google Scholar until 30 August 2024 for systematic review. The risk of bias using a mixed methods appraisal tool (MMAT, version 2018).

The systematic review included 53 studies that involved 15,997,163 women. About half of the studies were cohorts and have been published since 2020 which indicates an increase attention to pregnancy, childbirth, and reproductive health in this group of chronic diseases. The most common ARDs that were reviewed in terms of maternal and fetal cardiac outcomes were systemic lupus erythematosus and Takayasu Arthritis. The most common cardiovascular adverse outcome reported in pregnant women with ARDs was preeclampsia-eclampsia and in the fetus/newborn was congenital heart block. Adverse maternal and fetal/neonatal cardiac outcomes in pregnant women with rheumatoid arthritis were controversial. Most studies (96%) had at least one area of risk of bias.

This study emphasizes the critical role of comprehensive collaborative care in managing ARD-complicated pregnancies. Also will ensure that care tailored to the particular challenges of ARD during pregnancy improves outcomes for both mother and fetus.