{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T22:17:15Z","timestamp":1790201835278,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2015,6,29]],"date-time":"2015-06-29T00:00:00Z","timestamp":1435536000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Australian National Health and Medical Research Council (NHMRC)","award":["APP1001066"],"award-info":[{"award-number":["APP1001066"]}]},{"name":"Australian Heart Foundation"},{"name":"NHMRC Senior Research Fellowship","award":["APP1021025"],"award-info":[{"award-number":["APP1021025"]}]},{"name":"Australian Research Council Future Fellowship","award":["FT120100069"],"award-info":[{"award-number":["FT120100069"]}]},{"name":"NHMRC Career Development Fellowship","award":["APP1062262"],"award-info":[{"award-number":["APP1062262"]}]},{"name":"Heart Foundation (Australia) Future Leader Fellowship"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Historically, pregnancies among women with prosthetic heart valves have been associated with an increased incidence of adverse outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Systematic review to assess risk of adverse pregnancy outcomes among women with a prosthetic heart valve(s) over the last 20\u00a0years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search strategy<\/jats:title><jats:p>Electronic literature search of Medline, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature and Embase to find recent studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection criteria<\/jats:title><jats:p>Studies of pregnant women with heart valve prostheses including trials, cohort studies and unselected case series.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data collection and analysis<\/jats:title><jats:p>Primary analysis calculated absolute risks and 95% confidence intervals (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>) for pregnancy outcomes using a random effects model. The Freeman\u2013Tukey transformation was utilised in secondary analysis due to the large number of individual study outcomes with zero events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>Eleven studies capturing 499 pregnancies among women with heart valve prostheses, including 256 mechanical and 59 bioprosthetic, were eligible for inclusion. Pooled estimate of maternal mortality was 1.2\/100 pregnancies (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>0.5\u20132.2), for mechanical valves subgroup 1.8\/100 (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>0.5\u20133.7) and bioprosthetic subgroup 0.7\/100 (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>0.1\u20134.5), overall pregnancy loss 20.8\/100 pregnancies (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>9.5\u201335.1), perinatal mortality 5.0\/100 births (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>1.8\u20139.8) and thromboembolism 9.3\/100 pregnancies (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>4.0\u201316.5).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Women with heart valve prostheses experienced higher rates of adverse outcomes than expected in a general obstetric population; however, lower than previously reported. Women with bioprostheses had significantly fewer thromboembolic events compared to women with mechanical valves.\u00a0Women should be counselled pre\u2010pregnancy about risk\u00a0of maternal death and pregnancy loss. Vigilant surveillance\u00a0by a multidisciplinary team throughout the perinatal period remains warranted for these women and their infants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Metaanalysis suggests improvement in\u00a0#pregnancy outcomes among women with #heartvalveprostheses.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.13491","type":"journal-article","created":{"date-parts":[[2015,6,29]],"date-time":"2015-06-29T08:03:06Z","timestamp":1435564986000},"page":"1446-1455","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Prosthetic heart valves in pregnancy, outcomes for women and their babies: a systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"122","author":[{"given":"CM","family":"Lawley","sequence":"first","affiliation":[{"name":"Clinical Population Perinatal Health Research Kolling Institute University of Sydney Sydney NSW Australia"},{"name":"Department of Cardiology Royal North Shore Hospital St Leonards NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SJ","family":"Lain","sequence":"additional","affiliation":[{"name":"Clinical Population Perinatal Health Research Kolling Institute University of Sydney Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CS","family":"Algert","sequence":"additional","affiliation":[{"name":"Clinical Population Perinatal Health Research Kolling Institute University of Sydney Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JB","family":"Ford","sequence":"additional","affiliation":[{"name":"Clinical Population Perinatal Health Research Kolling Institute University of Sydney Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"GA","family":"Figtree","sequence":"additional","affiliation":[{"name":"Department of Cardiology Royal North Shore Hospital St Leonards NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CL","family":"Roberts","sequence":"additional","affiliation":[{"name":"Clinical Population Perinatal Health Research Kolling Institute University of Sydney Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,6,29]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(97)85765-1"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2003.10.028"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.95.10.2407"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-011-2137-x"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1521-6926(03)00021-5"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.2.191"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2012.03359.x"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2009.06.040"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2008.002840"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0049-3848(11)70016-0"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2012.69"},{"key":"e_1_2_6_13_1","first-page":"42","article-title":"Meta\u2010analyses of pregnancy outcomes in women with mechanical heart valves treated by different anticoagulant regimens","volume":"8","author":"Li T","year":"2008","journal-title":"J Evidence\u2010based Med"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1681.2008.05099.x"},{"key":"e_1_2_6_15_1","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.jacc.2008.05.007","article-title":"2008 focused update incorporated into the ACC\/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons","volume":"52","author":"Bonow RO","year":"2008","journal-title":"J Am Coll Cardiol"},{"key":"e_1_2_6_16_1","unstructured":"RCOG.Heart disease and pregnancy study group statement. Consensus views arising from the 51st study group: Heart disease and pregnancy.2013[http:\/\/www.rcog.org.uk\/womens-health\/clinical-guidance\/heart-disease-and-pregnancy-study-group-statement]. Accessed 10 July 2013."},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.01.005"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.627224"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.03.085"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2004.12.002"},{"key":"e_1_2_6_21_1","first-page":"448","article-title":"Pregnancy with prosthetic heart valves\u201430\u00a0years\u2019 nationwide experience in Denmark","volume":"40","author":"Sillesen M","year":"2011","journal-title":"Eur J Cardio\u2010thorac Surg"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.000953"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/2046-4053-3-8"},{"key":"e_1_2_6_24_1","volume-title":"Neonatal and Perinatal Mortality: Country, Regional and Global Estimates","author":"WHO","year":"2006"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1214\/aoms\/1177729756"},{"key":"e_1_2_6_26_1","unstructured":"WellsGA SheaB O'ConnellD PetersonJ WelchV LososM et\u00a0al.The Newcastle\u2013Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta\u2010analyses.2008[http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp]. Accessed 20 August 2014."},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2008.12.005"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/1753495X13514382"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.10.899"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2007.22.2.258"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.5830\/CVJA-2012-022"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2012.11.022"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.crvasa.2012.06.003"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/1076029610371470"},{"key":"e_1_2_6_36_1","first-page":"117","article-title":"Pregnancy outcome after mechanical mitral valve replacement: a prospective study","volume":"7","author":"Samiei N","year":"2012","journal-title":"J Tehran Univ Heart Center"},{"key":"e_1_2_6_37_1","doi-asserted-by":"crossref","DOI":"10.1596\/978-92-4-150722-6","volume-title":"Trends in Maternal Mortality: 1990 to 2013","author":"WHO","year":"2014"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta9020"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr218"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs109"},{"issue":"11","key":"e_1_2_6_41_1","first-page":"I294","article-title":"Very long\u2010term survival implications of heart valve replacement with tissue versus mechanical prostheses in adults <60\u00a0years of age","volume":"116","author":"Ruel M","year":"2007","journal-title":"Circulation"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2003.12.058"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.99.5.655"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2008.08.004"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.1161\/hc3001.093437"},{"key":"e_1_2_6_46_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.96.9.2789"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182733d56"},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.183056"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2F1471-0528.13491","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.13491","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T22:24:30Z","timestamp":1748471070000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.13491"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,6,29]]},"references-count":47,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2015,10]]}},"alternative-id":["10.1111\/1471-0528.13491"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.13491","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,6,29]]},"assertion":[{"value":"2015-04-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-06-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}