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Meta-Analysis
. 2017 Jul 1;3(3):198-207.
doi: 10.1093/ehjqcco/qcw060.

Incidence of myocardial infarction in pregnancy: a systematic review and meta-analysis of population-based studies

Paul Gibson  1 , Mariam Narous  2 , Tabassum Firoz  3 , Doris Chou  4 , Maria Barreix  4 , Lale Say  4 , Matthew James  5 ; WHO Maternal Morbidity Working Group
Affiliations
Meta-Analysis

Incidence of myocardial infarction in pregnancy: a systematic review and meta-analysis of population-based studies

Paul Gibson et al. Eur Heart J Qual Care Clin Outcomes. .

Abstract

Aims: Cardiac disease is one of the leading causes of indirect maternal death, and myocardial infarction (MI) is one of its most common aetiologies. The objectives of this systematic review and meta-analysis were to characterize the incidence of pregnancy-associated MI (PAMI), as well as the maternal mortality and the case-fatality rates due to PAMI.

Methods and results: Articles were obtained by searching electronic databases, bibliographies and conference proceedings with no language or date restrictions. Two reviewers independently selected population-based cohort and case-control studies reporting on incidence, mortality and case-fatality rates for pregnancy-associated MI. Meta-analysis was performed to estimate pooled maternal incidence, mortality and case-fatality rates. Meta-regression was performed to explore heterogeneity. Based on 17 included studies, the pooled incidence of PAMI and maternal mortality from PAMI were 3.34 (2.09-4.58) and 0.20 (0.10-0.29) per 100 000 pregnancies, respectively. The case-fatality rate was 5.03% (3.78-6.27%). Country/region (meta-regression P = 0.006) and years of study (meta-regression P = 0.04) were potential explanations for the observed heterogeneity in the pooled incidence estimates of maternal MI and its associated mortality, with more recent studies and those conducted in the USA revealing the highest rates.

Conclusion: This article provides a global estimate of the incidence, mortality rate, and case fatality rate of pregnancy-associated MI. We identified higher rates of PAMI in the USA (relative to Canada and European countries) and rising rates over time. Further research regarding this population is needed, especially given rising maternal age and the increasing prevalence of cardiovascular risk factors.

Keywords: Incidence; Maternal; Morbidity; Mortality; Myocardial infarction; Pregnancy.

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Figures

Figure 1
Figure 1
Article flow diagram.
Figure 2
Figure 2
Forest plot of incidence of pregnancy-associated myocardial infarction.
Figure 3
Figure 3
Forest plot of incidence of maternal mortality due to pregnancy-associated myocardial infarction.
Figure 4
Figure 4
Forest plot of case-fatality rate due to pregnancy-associated myocardial infarction.
See this image and copyright information in PMC

Comment in

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