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Experiences of women with cardiac disease in pregnancy: a systematic review and metasynthesis
  1. Angela J Dawson1,
  2. Yordanka Krastev1,2,
  3. William A Parsonage3,4,
  4. Michael Peek5,6,
  5. Karin Lust7,
  6. Elizabeth A Sullivan1
  1. 1 Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
  2. 2 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
  3. 3 Department of Cardiology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
  4. 4 Australian Centre for Health Service Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
  5. 5 Department of Obstetrics and Gynaecology, Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
  6. 6 Department of Obstetrics, Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia
  7. 7 Department of Obstetrics and Gynaecology, Women’s and Newborn Services, Royal Brisbane and Women’s Hospital, University of Queensland, Brisbane, Queensland, Australia
  1. Correspondence to Professor Elizabeth A Sullivan; elizabeth.sullivan{at}


Objective Cardiac disease in pregnancy is a leading cause of maternal death in high-income countries. Evidence-based guidelines to assist in planning and managing the healthcare of affected women is lacking. The objective of this research was to produce the first qualitative metasynthesis of the experiences of pregnant women with existing or acquired cardiac disease to inform improved healthcare services.

Method We conducted a systematic search of peer-reviewed publications in five databases to investigate the decision-making processes, supportive strategies and healthcare experiences of pregnant women with existing or acquired cardiac disease, or of affected women contemplating pregnancy. Identified publications were screened for duplication and eligibility against selection criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We then undertook a thematic analysis of the data relating to women’s experiences extracted from each publication to inform new healthcare practices and communication.

Results Eleven studies from six countries were included in our meta-synthesis. Four themes were revealed. Women with congenital and acquired heart disease identified situations where they had either taken charge of decision-making, lacked control or experienced emotional uncertainty when making decisions. Some women were risk aware and determined to take care of themselves in pregnancy while others downplayed the risks. Women with heart disease acknowledged the importance of specific social support measures during pregnancy and after child birth, and reported a spectrum of healthcare experiences.

Conclusions There is a lack of integrated and tailored healthcare services and information for women with cardiac disease in pregnancy. The experiences of women synthesised in this research has the potential to inform new evidence-based guidelines to support the decision-making needs of women with cardiac disease in pregnancy. Shared decision-making must consider communication across the clinical team. However, coordinated care is challenging due to the different specialists involved and the limited clinical evidence concerning effective approaches to managing such complex care.

  • pregnancy
  • cardiac disease
  • women centered care
  • shared decision-making
  • qualitative meta-synthesis

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  • Contributors The study was conceived by EAS. EAS and AJD designed the study. YK undertook the literature search and screening with assistance from AJD. YK, AJD and EAS critically appraised the papers. YK and AJD undertook the initial analysis with input from all authors (EAS, KL, MP and WAP). AJD and YK wrote the first draft of the manuscript with input from EAS. All authors contributed to revisions; and editing and approving the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data used in this meta-synthesis are available in the public domain.

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