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In this systematic review and meta\u2010analysis, we aimed to investigate the outcomes of pregnancies affected by EA or tricuspid valve dysplasia (TVD) with circular shunt, focusing on two prenatal management approaches: (1) expectant management (EM) and (2) transplacental non\u2010steroidal anti\u2010inflammatory drugs (NSAID) therapy. We searched PubMed, Scopus, and Web of Science systematically from its inception until June 2023. The random\u2010effect model was used to pool the data. Heterogeneity was assessed using the <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> value. Twenty\u2010one studies with a total of 610 fetuses with EA\/TVD with circular shunt were included in the synthesis, of which 17 studies (583 fetuses) were on EM and 4 studies (27 fetuses) used transplacental NSAID therapy. The NSAID group had higher rates of moderate to severe tricuspid regurgitation, hydrops, and pericardial effusion on prenatal ultrasound compared with the EM group. However, ductal constriction was achieved in 81% of NSAID cases, mitigating the disease pathophysiology, although 65% of them experienced oligohydramnios. Notably, the NSAID group showed significantly higher rates of live birth (86%) and survival to hospital discharge (89%) compared with the EM group (67% and 43%, respectively). Despite these promising results, it's important to acknowledge that the number of cases treated with NSAIDs was small, with limited safety data. Therefore, caution is advised in interpreting these findings, and patients considering NSAID therapy should be informed about these limitations. Future multicenter studies are necessary to further explore the safety and effectiveness of NSAID therapy in this particular population.<\/jats:p>","DOI":"10.1002\/pd.6446","type":"journal-article","created":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T11:52:20Z","timestamp":1698666740000},"page":"773-782","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Transplacental non\u2010steroidal anti\u2010inflammatory drugs versus expectant management in fetal Ebstein anomaly with circular shunt: Systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5611-1231","authenticated-orcid":false,"given":"Hiba J.","family":"Mustafa","sequence":"first","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine Indiana University School of Medicine  Indianapolis Indiana USA"},{"name":"The Fetal Center at Riley Children's and Indiana University Health  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9019-3904","authenticated-orcid":false,"given":"Faezeh","family":"Aghajani","sequence":"additional","affiliation":[{"name":"BCNatal Fetal Medicine Research Center Hospital Cl\u00ednic and Hospital Sant Joan de D\u00e9u Universitat de Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zinah A.","family":"Bairmani","sequence":"additional","affiliation":[{"name":"Department of Pharmacology &amp; 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