A Review on Heart disease in pregnancy: clinical spectrum, maternal functional status, and fetomaternal outcomes

Background: Heart disease in pregnancy is still a significant contributor to maternal and perinatal morbidity and mortality, especially in low- and middle-income nations where rheumatic heart disease (RHD) is still common. This systematic review synthesizes evidence on the clinical spectrum, maternal functional assessment along with fetomaternal outcomes in pregnancy with heart disease.

Methods: a comprehensive literature search was conducted in PubMed, Scopus, Embase, Web of science and Cochrane Library database for studies published between January 2000 and December 2025. Studies reporting data on pregnant women with structural or functional heart disease were included. Primary outcomes were maternal mortality, heart failure and perinatal mortality. Secondary outcome included mode of delivery, preterm birth, low birth weight, and NICU admission. Risk of bias was assessed using the Newcastle-Ottawa scale for observational studies. Data were synthesized narratively due to heterogeneity.

Results:  Twenty-nine studies met inclusion criteria, encompassing 15,997,163 women across 23 countries. Rheumatic heart disease constituted 60-80% of cases in LMICs, with mitral stenosis being the most clinically significant lesion. Maternal functional status (NYHA class III/IV) emerged as the strongest predictor of adverse outcomes, with relative risk of 2.86 (95% CI 1.54-5.33) for preterm birth and 3.23 (95% CI 1.92-5.44) for perinatal death. Severe mitral stenosis was associated with significantly higher rates of preterm birth (RR 0.29, 95% CI 0.13-0.64) and postpartum arrhythmias (RR 0.07, 95% CI 0.04-0.12). maternal mortality ranged from 1-34%, with highest rate in LMIC setting and among women with pulmonary hypertension or severe left obstruction.

Conclusion: Heart disease in pregnancy carries significant risks that are primarily determined by the type and severity of cardiac lesion and maternal functional status. Multidisciplinary approach along with early diagnosis and multidisciplinary care are crucial to reduce morbidity and mortality in high-risk population