心肌病女性妊娠结局的前瞻性队列研究
英国前瞻性观察性研究纳入209名孕前确诊心肌病的女性共210次妊娠，通过UKOSS系统收集2021年6月至2024年5月的数据。结果显示无孕产妇死亡，10%发生心力衰竭，8%发生心律失常，中位分娩孕周38.1周，20%新生儿入住新生儿病房。研究提示在英国管理下的心肌病孕妇通常有良好结局。
要点
- 孕前心肌病女性妊娠无孕产妇死亡，孕期心力衰竭发生率10%，心律失常发生率8%
- 单胎妊娠中位分娩孕周38.1周(IQR 259-273周)，20%新生儿需入住新生儿病房
- 扩张型心肌病占49.3%，肥厚型占19.1%，既往围产期心肌病占11.5%
核心结论
- 在英国管理的心肌病女性妊娠通常有成功结局，与已发表数据一致
- 孕产妇心脏并发症发生率较低，无孕产妇死亡
研究设计与样本
- 前瞻性观察性研究，使用英国产科监测系统(UKOSS)，数据收集时间为2021年6月1日至2024年5月31日
- 纳入209名孕前确诊心肌病的女性共210次妊娠
主要发现
- 扩张型心肌病103例(49.3%)，肥厚型40例(19.1%)，既往围产期心肌病24例(11.5%)，致心律失常性右室心肌病11例(5.3%)，其他心肌病31例(14.8%)
- 206次单胎妊娠中位分娩孕周为38.1周(IQR 259-273)
- 10%女性孕期发生心力衰竭，8%发生心律失常
- 36/180(20%)有记录的新生儿入住新生儿病房
- 无孕产妇死亡
临床怎么用
- 孕前心肌病女性妊娠需要多学科管理和密切监测
- 需警惕孕期心力衰竭和心律失常的发生
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
ABSTRACT Objective To establish in a national cohort whether the type of cardiomyopathy in women with a prepregnancy diagnosis affected pregnancy outcomes including mortality, gestational age at birth, and delivery type. Design Prospective Observational study using United Kingdom Obstetric Surveillance System (UKOSS). Population Women with pre-pregnancy diagnosis of cardiomyopathy. Methods Cases included were defined as women with pre-pregnancy diagnosis of cardiomyopathy (dilated cardiomyopathy, hypertrophic cardiomyopathy, arrhymogenic right ventricular cardiomyopathy, or Peripartum Cardiomyopathy (PPCM)). Details were notified monthly to UKOSS (1st June 2021 until the 31st May 2024). Main Outcome Measures Obstetric, neonatal, and cardiovascular outcomes. Results 210 pregnancies in 209 women were identified, 103/209 (49.3%) with dilated cardiomyopathy, 40/209 (19.1%) with hypertrophic cardiomyopathy, 24/209 (11.5%) with previous PPCM, 11/209 (5.3%) with arrhythmogenic right ventricular cardiomyopathy and 31/209 (14.8%) women with ‘other’ cardiomyopathies. Median gestation at delivery in 206 singleton pregnancies was 38.1 (IQR 259–273) weeks; 36/180 (20%) of babies with data recorded were admitted to the neonatal unit. There were no maternal deaths. 10% of women had a documented episode of heart failure and 8% a documented arrhythmia during pregnancy. Conclusions Pregnancies in women with cardiomyopathy managed in the UK typically have successful outcomes, consistent with published data. Maternal cardiac complications rate was small. There were no maternal deaths.
引用
- BJOG：Pregnancy and Cardiomyopathy: A Prospective Cohort Study
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。