{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:51:50Z","timestamp":1791262310680,"version":"4.1.0"},"reference-count":78,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"abstract":"ABSTRACT<\/jats:title>\n \n Introduction<\/jats:title>\n Cardiovascular conditions represent a leading cause of indirect maternal morbidity, making delivery planning a critical component of care in affected pregnancies. To evaluate the delivery mode selection in pregnancies complicated by cardiac disease, stratified by disease severity according to the modified World Health Organization (mWHO) staging system.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted comprehensive searches in four major electronic databases (PubMed, Web of Science, Scopus, and Embase) for literature published through July 11, 2025. The electronic search was supplemented by manual screening of reference lists from included studies. We included peer\u2010reviewed English full\u2010text studies with \u2265\u200915 participants that reported delivery modes in pregnant women with cardiac disease, categorized by mWHO stages (I\u2010IV). Both observational and interventional study designs were eligible. Our primary outcome was the rate of cesarean delivery (CS), with assisted vaginal delivery (AVD) rates analyzed as a secondary outcome. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. We performed random\u2010effects meta\u2010analyses to pool delivery method prevalence estimates. Subgroup analyses stratified studies by country income level (World Bank gross national income per capita categories) to examine socioeconomic influences on delivery choice.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n From 26 eligible cohort studies (\n n<\/jats:italic>\n \u2009=\u200989,333 pregnancies with cardiac disease), 24 met quality criteria for meta\u2010analysis. Pooled CS rates increased progressively with mWHO severity: Stage I (40.6% [95% CI: 28.8%\u201352.4%]), Stage II (43.4% [95% CI: 31.5%\u201355.4%]), Stage II\/III (50.0% [95% CI: 36.5%\u201363.5%]), Stage III (56.0% [95% CI: 42.0%\u201370.0%]), and Stage IV (67.8% [95% CI: 50.4%\u201385.2%]). For combined risk categories, low\u2010risk (mWHO I\u2010II) pregnancies showed lower intervention rates (CS: 39.2% [95% CI: 32.8%\u201345.7%]; AVD: 13.9% [95% CI: 7.0%\u201320.8%]) compared to high\u2010risk (mWHO III\u2010IV) pregnancies (CS: 57.7% [95% CI: 49.1%\u201366.2%]; AVD: 16.6% [95% CI: 8.6%\u201324.7%]). Notably, higher\u2010income countries demonstrated significantly lower CS rates in both low\u2010 and high\u2010risk groups (\n p<\/jats:italic>\n \u2009<\u20090.05), suggesting socioeconomic influences on delivery decisions.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This study documents concerning CS overuse in cardiac pregnancies with disease severities. Current guidelines recommend vaginal delivery as standard practice, reserving surgical intervention for specific obstetric or critical cardiac conditions. However, our findings suggest a substantial gap between clinical practice and current guideline recommendations in this regard, requiring extensive attention.<\/jats:p>\n <\/jats:sec>\n \n \n PROSPERO<\/jats:styled-content>\n Registration\n <\/jats:title>\n The review protocol was registered on 11\/10\/2024 under reference number CRD42024608358.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/birt.70124","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:12:02Z","timestamp":1791259922000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Delivery Choice in Pregnancies Complicated by Cardiac Disease: A Systematic Review and Meta\u2010Analysis Based on Modified World Health Organization Staging"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7764-0319","authenticated-orcid":false,"given":"Mohammadamin","family":"Parsaei","sequence":"first","affiliation":[{"name":"Postdoctoral Research Fellow, Breastfeeding Research Center, Family Health Research Institute Tehran University of Medical Sciences Tehran Iran"},{"name":"ZenNovid Foundation Carrboro North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7273-544X","authenticated-orcid":false,"given":"Elaheh","family":"Karimi","sequence":"additional","affiliation":[{"name":"Tehran Heart Center, Cardiovascular Disease Research Institute Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyedeh Mahsa","family":"Mohammadian","sequence":"additional","affiliation":[{"name":"School of Medicine Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3779-9218","authenticated-orcid":false,"given":"Sedigheh","family":"Hantoushzadeh","sequence":"additional","affiliation":[{"name":"Vali\u2010e\u2010Asr Reproductive Health Research Center, Family Health Research Institute Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1137-983X","authenticated-orcid":false,"given":"Bahram","family":"Salmanian","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Colorado Health Anschutz Medical Campus Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"issue":"7","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1038\/s41372-023-01625-4","article-title":"Mode of Delivery Among Women With Maternal Cardiac Disease","volume":"43","author":"Gavin N. 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