CARDIAC VALVE DISEASE IN DIABETIC PREGNANT WOMEN: FETAL COMPROMISE AND MATERNAL RISK
DOI:
https://doi.org/10.36557/2674-8169.2024v6n8p3156-3171Palavras-chave:
Cardiac valve disease, Diabetic pregnant women, Fetal compromise, Maternal risk and Diabetes mellitusResumo
Introduction: Cardiac valve diseases represent a significant concern in the management of pregnant women, particularly those with diabetes mellitus, a condition that alters the hemodynamic profile and can exacerbate pre-existing cardiac issues. During pregnancy, a woman's body undergoes physiological changes that can affect the function of the cardiac valves. Diabetes mellitus can accelerate the progression of valvulopathies, leading to complications affecting both the mother and the fetus. Fetal compromise often results from maternal hemodynamic instability and changes in blood flow, while maternal risk includes worsening cardiac symptoms and an increased likelihood of adverse events during pregnancy. Objective: The objective of this systematic review was to analyze the available evidence on the impact of cardiac valve diseases in diabetic pregnant women, focusing on the consequences for the fetus and the risks for the mother. Methodology: To conduct the systematic review, the PRISMA checklist criteria were followed. The search was performed in electronic databases, including PubMed, Scielo, and Web of Science, using five main descriptors: "cardiac valve disease," "diabetic pregnant women," "fetal compromise," "maternal risk," and "diabetes mellitus." Studies published in the last 10 years were included, prioritizing peer-reviewed articles and original research. Inclusion criteria comprised: (1) studies specifically addressing valvulopathies in pregnant women with diabetes mellitus, (2) articles providing data on fetal and maternal outcomes, and (3) research published in peer-reviewed journals. Exclusion criteria included: (1) studies not directly focusing on diabetic pregnant women, (2) research with non-rigorous methodologies or lack of relevant data, and (3) articles published more than 10 years ago. Results: The results indicated that pregnant women with valvulopathies and diabetes mellitus face a heightened risk of complications. Key findings included increased neonatal mortality and maternal cardiovascular complications, such as heart failure and worsening valvular symptoms. Fetal compromise often involved intrauterine growth problems and a higher incidence of prematurity. Conclusion: The review highlighted that the combination of diabetes mellitus and cardiac valve diseases presents a significant challenge in managing pregnant women, with important implications for both maternal and fetal health. Early identification and appropriate management of valvulopathies are crucial to reducing associated risks and improving outcomes for both mother and baby. Future studies should focus on treatment strategies and monitoring approaches that can mitigate these complications and promote better outcomes.
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Briceño Revillo JM, Ramon Y Cajal Calvo J, Melero Polo J, Cueva Recalde JF, Ibañez Muñoz D. Variante de la anatomía de los músculos papilares como causa de insuficiencia mitral. Un caso de válvula mitral asimétrica en paracaídas-like [Anatomy variant of the papillary muscles as a cause of mitral regurgitation. Case report of a parachute-like asymmetric mitral valve]. Rev Fac Cien Med Univ Nac Cordoba. 2021;78(4):402-404. Published 2021 Dec 28. doi:10.31053/1853.0605.v78.n4.33876
Amat-Santos IJ, García-Gómez M, de Marco F, et al. Latest-iteration balloon- and self-expandable transcatheter valves for severe bicuspid aortic stenosis: the TRITON study. Rev Esp Cardiol (Engl Ed). 2023;76(11):872-880. doi:10.1016/j.rec.2023.03.002
Rafel Ribera J, Casañas Muñoz R, Anguera Ferrando N, Batalla Sahún N, Castro Cels A, Pujadas Capmany R. Valvulopatía cardíaca asociada al uso de benfluorex [Valvular heart disease associated with benfluorex]. Rev Esp Cardiol. 2003;56(2):215-216. doi:10.1016/s0300-8932(03)76849-3
Salinas P, Moreno R, Calvo L, et al. Long-term Follow-up After Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis. Rev Esp Cardiol (Engl Ed). 2016;69(1):37-44. doi:10.1016/j.rec.2015.03.017
Santibáñez Escobar F. La insuficiencia cardiaca en la valvulopatía aórtica: pronóstico y tratamiento [Heart insufficiency in aortic valve disease: prognosis and treatment]. Arch Cardiol Mex. 2002;72 Suppl 1:S212-S215.
Toscano M, Neves Z, Matias C, et al. Pacemaker lead as an iatrogenic cause of right heart failure: Case report. Electrocatéter como causa iatrogénica de insuficiência cardíaca direita – relato de um caso. Rev Port Cardiol (Engl Ed). 2019;38(9):675.e1-675.e5. doi:10.1016/j.repc.2018.01.014
Rodríguez Hernández JE, Maroto Castellanos LC. La cirugía convencional sigue siendo la mejor opción en el tratamiento quirúrgico de la valvulopatía aórtica. Argumentos en contra [Conventional surgery continues to be the best option for surgical treatment of aortic valve disease. Arguments against]. Rev Esp Cardiol. 2000;53(4):483-489.
Hornero Sos F, Atienza Fernández F, Montero Argudo JA, et al. Auriculectomía parcial izquierda en el tratamiento de la fibrilación auricular por valvulopatía mitral [Partial left atriectomy in the treatment of atrial fibrillation associated with mitral valve disease]. Rev Esp Cardiol. 2001;54(6):703-708.
Hornero Sos F, Montero Argudo JA, Canovas López S, et al. Remodelado anatómico auricular tras la cirugía de la valvulopatía mitral con fibrilación auricular permanente [Anatomic atrial remodeling after mitral valve surgery in permanent atrial fibrillation]. Rev Esp Cardiol. 2003;56(7):674-681. doi:10.1016/s0300-8932(03)76938-3
Caralps i Riera JM, Montiel Serrano J, Ruyra Baliarda X, Litvan Suquieri H, Carreras Costa F. Trombosis arterial pulmonar en una paciente con valvulopatía mitro-tricuspídea. Valor añadido del ecocardiograma transesofágico peroperatorio [Pulmonary artery thrombosis in a patient with mitral-tricuspid valve disease. Added value of peroperative transesophageal echocardiogram]. Rev Esp Cardiol. 1996;49(8):621-622.
Fraile JR, Gómez-Arnau J, Cervera JS, Escarpa A, Díez-Lobo AI, Peral P. Buprenorfina en cirugía cardíaca. Estudio hemodinámico en pacientes portadores de valvulopatía mitral [Buprenorphine in heart surgery. Hemodynamic study in patients with mitral valve disease]. Rev Esp Anestesiol Reanim. 1988;35(5):245-248.
Lee WL, Chang WH, Wang PH. Diabetic pregnant women and perinatal outcomes. Taiwan J Obstet Gynecol. 2023;62(6):789-791. doi:10.1016/j.tjog.2023.09.012
Choudhury AA, Devi Rajeswari V. Gestational diabetes mellitus - A metabolic and reproductive disorder. Biomed Pharmacother. 2021;143:112183. doi:10.1016/j.biopha.2021.112183
Kusinski LC, Murphy HR, De Lucia Rolfe E, et al. Dietary Intervention in Pregnant Women with Gestational Diabetes; Protocol for the DiGest Randomised Controlled Trial [published correction appears in Nutrients. 2020 Jun 17;12(6):E1793. doi: 10.3390/nu12061793]. Nutrients. 2020;12(4):1165. Published 2020 Apr 22. doi:10.3390/nu12041165
Mathiesen ER, Alibegovic AC, Corcoy R, et al. Insulin degludec versus insulin detemir, both in combination with insulin aspart, in the treatment of pregnant women with type 1 diabetes (EXPECT): an open‑label, multinational, randomised, controlled, non-inferiority trial [published correction appears in Lancet Diabetes Endocrinol. 2023 May;11(5):e7. doi: 10.1016/S2213-8587(23)00096-7] [published correction appears in Lancet Diabetes Endocrinol. 2023 Aug;11(8):e10. doi: 10.1016/S2213-8587(23)00169-9]. Lancet Diabetes Endocrinol. 2023;11(2):86-95. doi:10.1016/S2213-8587(22)00307-2
Girma A, Aemiro A, Workineh D, Tamir D. Magnitude, Associated Risk Factors, and Trend Comparisons of Urinary Tract Infection among Pregnant Women and Diabetic Patients: A Systematic Review and Meta-Analysis. J Pregnancy. 2023;2023:8365867. Published 2023 Jul 28. doi:10.1155/2023/8365867
Kumar A, Vanamail P, Gupta RK, Husain SA. Prediction of pre-eclampsia in diabetic pregnant women. Indian J Med Res. 2023;157(4):330-344. doi:10.4103/ijmr.IJMR_1594_19
Wu S, Jin J, Hu KL, Wu Y, Zhang D. Prevention of Gestational Diabetes Mellitus and Gestational Weight Gain Restriction in Overweight/Obese Pregnant Women: A Systematic Review and Network Meta-Analysis. Nutrients. 2022;14(12):2383. Published 2022 Jun 9. doi:10.3390/nu14122383
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Copyright (c) 2024 Breno Henrique Rocha, Regivaldo Rodrigues da Costa Filho , Marcelo da Silva Moura , Sarah Cristina Durães de Souza , Milena Arpini Machado, Anny Karollynny Batista de Oliveira Neves, Ariel Ferreira Paula , Gabriel Felipe Oliveira , Maristela Silva Machado , João Pedro de Paula Piveta , Camylla Silva Gomes Paulino, Sayonara Aparecida Bramatti , Eloisy Stefany de Souza Vales
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Os autores são detentores dos direitos autorais mediante uma licença CCBY 4.0.
