Predictive accuracy of four scoring systems for cardiovascular complications during pregnancy in women with congenital heart disease: A systematic review and meta-analysis
- VernacularTitle:四种风险评分对先心病女性妊娠心血管并发症预测准确性的系统评价与Meta分析
- Author:
Chenyang MA
1
;
Menglin TANG
2
Author Information
1. West China School of Nursing, Sichuan University/Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
2. West China School of Nursing, Sichuan University/Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
- Publication Type:Journal Article
- Keywords:
Congenital heart disease;
pregnancy;
cardiovascular complications;
risk scoring system;
CARPREG score;
ZAHARA score;
mWHO classification;
systematic review/meta-analysis
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2026;33(03):454-460
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the predictive value of four risk scoring systems for cardiovascular complications during pregnancy in patients with congenital heart disease (CHD). Methods Computer searches were conducted in PubMed, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, and China Biology Medicine disc (CBM). Relevant studies on risk scoring systems for cardiovascular complications during pregnancy in CHD patients at home and abroad were comprehensively collected. The retrieval period was from the establishment of the databases to January 1, 2025, and the retrieval was updated on March 26, 2025. After two reviewers independently screened the literature and extracted the data, the quality assessment was carried out, and meta-analysis was performed using MedCalc software. Results A total of 11 studies were included, with a total of 4 987 patients. The incidence of cardiovascular complications during pregnancy in CHD patients ranged from 6.72% to 28.84%. The QUADAS-2 scoring tool results showed that 2 studies had unclear risk of bias, and 9 studies were determined to have a high risk of bias. The results of the meta-analysis showed that the CARPREGⅠ score [AUC=0.709, 95%CI (0.672, 0.745), P<0.001], CARPREGⅡ score [AUC=0.757, 95%CI (0.720, 0.794), P<0.001], ZAHARA score [AUC=0.732, 95%CI (0.674, 0.790), P<0.001], and mWHO classification system [AUC=0.681, 95%CI (0.617, 0.745), P<0.001] could independently predict cardiovascular complications during pregnancy in CHD patients. Conclusion The existing evidence indicates that all four scoring systems can be used to predict cardiovascular complications during pregnancy in CHD patients. Although the CARPREGⅡ score has the highest accuracy, the number of included studies is small. It is recommended to give priority to using the ZAHARA score for risk stratification and pregnancy management of women with CHD before pregnancy. In view of the limitations of the quality of the included studies, this study needs to be further confirmed by high-quality studies.
