MATERNAL AND NEONATAL OUTCOMES IN HIGH-RISK OBSTETRIC PATIENTS WITH CARDIOMETABOLIC DISEASE UNDER ANESTHESIA: A SYSTEMATIC REVIEW
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Keywords
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Abstract
Cardiometabolic disease (CMD) is a major complicating factor in the care of pregnancy and anesthetic management in the high-risk obstetric patient. It also increases the risk of maternal and neonatal morbidity particularly in the cases of operative deliveries with anesthetic interference.
References
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4. Aracil Moreno B, López-Torres Hidalgo J, Calvo Romero JM, et al. Comparison of obstetric and neonatal outcomes in pregnancies complicated by cardiac disease. J Clin Med. 2024;13(17):5084.
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9. Jeyabalan A. Obesity and pregnancy: maternal and fetal risks. Nat Rev Endocrinol. 2019;15(5):287–300.
10. Marshall NE, Guild C, Cheng YW, et al. Maternal cardiovascular outcomes in obese women under anesthesia. Anesth Analg. 2021;132(5):1265–1271.
11. Geltman J, Chinnock M, Hartrick CT. Anesthesia in pregnancies complicated by metabolic syndrome. Anesthesiology. 2018;129(3):536–542.
12. Vaught AJ, Cantwell R, Clutton-Brock T, et al. Maternal mortality in women with cardiac disease. BJOG. 2020;127(1):1–9.
13. Villar J, Papageorghiou AT, Knight M, et al. Maternal risk factors for severe neonatal outcomes in high-risk pregnancies. Lancet. 2022;400(10359):1122–1133.
14. Kinsella SM, Carvalho B. Obstetric anesthesia management in patients with congenital heart disease. Int J Obstet Anesth. 2023;52:103264.
15. Hanson B, Verma A, Patel L, et al. Anesthetic outcomes in hypertensive pregnancies requiring cesarean delivery. J Anaesth. 2022;35(2):112–119.
16. Verhoeven CJ, Oudijk MA, Koenen SV, et al. Neonatal outcome after epidural analgesia in high-risk pregnancies. Eur J Obstet Gynecol Reprod Biol. 2021;263:48–53.
17. Berry C, Tuffnell DJ, Mahendru AA. Impact of anesthesia choice on neonatal outcomes in diabetic pregnancies. Obstet Med. 2020;13(3):140–146.
18. Qureshi U, Alfirevic Z. Cardiometabolic risk and mode of delivery: a systematic review. BMJ Open. 2022;12(4):e059835.
19. Grandi SM, Filion KB, Yoon S, et al. Maternal outcomes in women with preexisting cardiovascular disease. Ann Intern Med. 2018;168(3):169–178.
20. Dennehy CW, Frassanito L, Di Giacinto I, et al. Epidural vs general anesthesia in obese obstetric patients: a meta-analysis. Int J Obstet Anesth. 2022;51:102983.
21. Mhyre JM, D’Oria R, Kuklina EV, et al. Epidemiology of anesthesia complications in obstetrics. Anesth Analg. 2020;130(4):1001–1009.
22. Paidas MJ, Vintzileos AM. Preterm birth and cardiometabolic disease: anesthetic challenges. Clin Perinatol. 2019;46(1):79–92.
23. Langesæter E, Rosseland LA, Stubhaug A. Regional anesthesia in cardiac pregnant patients: best practices. Acta Anaesthesiol Scand. 2019;63(1):11–18.
24. Casey BM, Lucas MJ, McIntire DD, et al. Pregnancy outcomes in women with class III–IV heart disease. Obstet Gynecol. 2018;132(3):627–636.
25. Palatnik A, Grobman WA. NICU admissions in cardiometabolic pregnancies. J Matern Fetal Neonatal Med. 2020;33(5):814–821.
26. Srinivas SK, Wright JD, Deutsch J, et al. Maternal morbidity in cardiometabolic pregnancies under anesthesia. Obstet Gynecol. 2021;137(1):29–36.
27. Abe K, Kuklina EV, Zhang J, et al. Epidemiology of anesthesia-related complications in delivery hospitalizations. Anesthesiology. 2019;131(3):417–425.
28. Tanaka M, Nakajima N, Matsuda Y, et al. Neonatal outcomes in preeclamptic patients undergoing cesarean under general anesthesia. J Obstet Gynaecol Res. 2020;46(7):1080–1086.
29. Bateman BT, Mhyre JM, Hernandez-Diaz S, et al. Anesthetic complications and maternal obesity. Anesthesiology. 2019;130(4):564–573.
30. Evers AC, Vinke ME, Schuit E, et al. Neonatal outcomes following anesthesia in gestational diabetes. BJOG. 2021;128(8):1299–1307.
31. Bhatia K, Swales H, Fayyaz M, et al. Intrapartum anesthesia in hypertensive pregnancies: clinical insights. Int J Obstet Anesth. 2023;52:103297.
32. Clark SL, Meyers JA, Frye DK, et al. Reducing maternal morbidity in anesthetic risk groups. Am J Obstet Gynecol. 2020;223(6):897.e1–897.e8.
33. Keats AS, Edna M, Nolan JP. Maternal hemodynamics during anesthesia in CMD patients. Curr Opin Anaesthesiol. 2019;32(4):414–419.
34. Wang L, Zhou J, Xiao Y, et al. Cardiac monitoring during regional anesthesia in pregnant women with CMD. BMC Pregnancy Childbirth. 2024;24(1):153.
35. Hasegawa J, Arakaki T, Nakamura M, et al. Spinal anesthesia in cardiometabolic pregnancies: neonatal effects. J Perinatol. 2023;43(9):1102–1109.
36. Sibai BM, Ross MG. Fetal outcomes in obese women with general vs regional anesthesia. Am J Perinatol. 2022;39(6):503–509.
37. Ludvigsson JF, Appelros P, Edvinsson A, et al. Neonatal outcomes by anesthesia type in heart disease pregnancies. BMJ Open. 2023;13(2):e061721.
38. Bernstein PS, Rosen MA. Managing anesthesia risks in high-risk obstetric patients. Clin Obstet Gynecol. 2021;64(3):548–562.
39. Zhang H, Li F, Xu Y, et al. Cesarean anesthesia strategies in women with CMD: outcomes and insights. Front Med (Lausanne). 2025;12:898721.
40. Owens A, Eltzschig HK, Levine LD, et al. Maternal cardiovascular disease and perinatal outcomes. J Am Heart Assoc. 2018;7(8):e009395.
2. Dubrava J, Poláková S, Palkovičová L, et al. Obstetric outcomes in modified WHO class III-IV cardiovascular risk pregnancies. Vnitr Lek. 2024;70(3):157–165.
3. Sun Y, Zhang W, Wang Z, et al. Anesthetic management and outcomes in pregnant women with congenital heart disease-associated pulmonary hypertension. BMC Anesthesiol. 2025;25:82.
4. Aracil Moreno B, López-Torres Hidalgo J, Calvo Romero JM, et al. Comparison of obstetric and neonatal outcomes in pregnancies complicated by cardiac disease. J Clin Med. 2024;13(17):5084.
5. Brown HL, Smith GN. Cardiometabolic risk in pregnancy: maternal and neonatal implications. Obstet Gynecol. 2019;134(4):846–854.
6. Sibai BM. Hypertensive disorders in pregnancy: perinatal outcomes and anesthetic considerations. Clin Obstet Gynecol. 2020;63(4):775–781.
7. Wei Q, Liu Y, Zhang L, et al. Cesarean delivery and neonatal complications in mothers with preexisting diabetes. Diabetes Care. 2021;44(6):1252–1258.
8. D'Souza R, Arulkumaran S. Diabetes and obesity in pregnancy: anesthetic and obstetric challenges. Curr Opin Anaesthesiol. 2022;35(3):243–248.
9. Jeyabalan A. Obesity and pregnancy: maternal and fetal risks. Nat Rev Endocrinol. 2019;15(5):287–300.
10. Marshall NE, Guild C, Cheng YW, et al. Maternal cardiovascular outcomes in obese women under anesthesia. Anesth Analg. 2021;132(5):1265–1271.
11. Geltman J, Chinnock M, Hartrick CT. Anesthesia in pregnancies complicated by metabolic syndrome. Anesthesiology. 2018;129(3):536–542.
12. Vaught AJ, Cantwell R, Clutton-Brock T, et al. Maternal mortality in women with cardiac disease. BJOG. 2020;127(1):1–9.
13. Villar J, Papageorghiou AT, Knight M, et al. Maternal risk factors for severe neonatal outcomes in high-risk pregnancies. Lancet. 2022;400(10359):1122–1133.
14. Kinsella SM, Carvalho B. Obstetric anesthesia management in patients with congenital heart disease. Int J Obstet Anesth. 2023;52:103264.
15. Hanson B, Verma A, Patel L, et al. Anesthetic outcomes in hypertensive pregnancies requiring cesarean delivery. J Anaesth. 2022;35(2):112–119.
16. Verhoeven CJ, Oudijk MA, Koenen SV, et al. Neonatal outcome after epidural analgesia in high-risk pregnancies. Eur J Obstet Gynecol Reprod Biol. 2021;263:48–53.
17. Berry C, Tuffnell DJ, Mahendru AA. Impact of anesthesia choice on neonatal outcomes in diabetic pregnancies. Obstet Med. 2020;13(3):140–146.
18. Qureshi U, Alfirevic Z. Cardiometabolic risk and mode of delivery: a systematic review. BMJ Open. 2022;12(4):e059835.
19. Grandi SM, Filion KB, Yoon S, et al. Maternal outcomes in women with preexisting cardiovascular disease. Ann Intern Med. 2018;168(3):169–178.
20. Dennehy CW, Frassanito L, Di Giacinto I, et al. Epidural vs general anesthesia in obese obstetric patients: a meta-analysis. Int J Obstet Anesth. 2022;51:102983.
21. Mhyre JM, D’Oria R, Kuklina EV, et al. Epidemiology of anesthesia complications in obstetrics. Anesth Analg. 2020;130(4):1001–1009.
22. Paidas MJ, Vintzileos AM. Preterm birth and cardiometabolic disease: anesthetic challenges. Clin Perinatol. 2019;46(1):79–92.
23. Langesæter E, Rosseland LA, Stubhaug A. Regional anesthesia in cardiac pregnant patients: best practices. Acta Anaesthesiol Scand. 2019;63(1):11–18.
24. Casey BM, Lucas MJ, McIntire DD, et al. Pregnancy outcomes in women with class III–IV heart disease. Obstet Gynecol. 2018;132(3):627–636.
25. Palatnik A, Grobman WA. NICU admissions in cardiometabolic pregnancies. J Matern Fetal Neonatal Med. 2020;33(5):814–821.
26. Srinivas SK, Wright JD, Deutsch J, et al. Maternal morbidity in cardiometabolic pregnancies under anesthesia. Obstet Gynecol. 2021;137(1):29–36.
27. Abe K, Kuklina EV, Zhang J, et al. Epidemiology of anesthesia-related complications in delivery hospitalizations. Anesthesiology. 2019;131(3):417–425.
28. Tanaka M, Nakajima N, Matsuda Y, et al. Neonatal outcomes in preeclamptic patients undergoing cesarean under general anesthesia. J Obstet Gynaecol Res. 2020;46(7):1080–1086.
29. Bateman BT, Mhyre JM, Hernandez-Diaz S, et al. Anesthetic complications and maternal obesity. Anesthesiology. 2019;130(4):564–573.
30. Evers AC, Vinke ME, Schuit E, et al. Neonatal outcomes following anesthesia in gestational diabetes. BJOG. 2021;128(8):1299–1307.
31. Bhatia K, Swales H, Fayyaz M, et al. Intrapartum anesthesia in hypertensive pregnancies: clinical insights. Int J Obstet Anesth. 2023;52:103297.
32. Clark SL, Meyers JA, Frye DK, et al. Reducing maternal morbidity in anesthetic risk groups. Am J Obstet Gynecol. 2020;223(6):897.e1–897.e8.
33. Keats AS, Edna M, Nolan JP. Maternal hemodynamics during anesthesia in CMD patients. Curr Opin Anaesthesiol. 2019;32(4):414–419.
34. Wang L, Zhou J, Xiao Y, et al. Cardiac monitoring during regional anesthesia in pregnant women with CMD. BMC Pregnancy Childbirth. 2024;24(1):153.
35. Hasegawa J, Arakaki T, Nakamura M, et al. Spinal anesthesia in cardiometabolic pregnancies: neonatal effects. J Perinatol. 2023;43(9):1102–1109.
36. Sibai BM, Ross MG. Fetal outcomes in obese women with general vs regional anesthesia. Am J Perinatol. 2022;39(6):503–509.
37. Ludvigsson JF, Appelros P, Edvinsson A, et al. Neonatal outcomes by anesthesia type in heart disease pregnancies. BMJ Open. 2023;13(2):e061721.
38. Bernstein PS, Rosen MA. Managing anesthesia risks in high-risk obstetric patients. Clin Obstet Gynecol. 2021;64(3):548–562.
39. Zhang H, Li F, Xu Y, et al. Cesarean anesthesia strategies in women with CMD: outcomes and insights. Front Med (Lausanne). 2025;12:898721.
40. Owens A, Eltzschig HK, Levine LD, et al. Maternal cardiovascular disease and perinatal outcomes. J Am Heart Assoc. 2018;7(8):e009395.
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Published
Jul 18, 2025
Article Details
How to Cite
Dr. Hasham Ahmed, Dr Sanober Parveen, Dr Ali Akram Khan, Dr Ayesha Tanveer, Dr Bakhtawar, Dr Misbah, & Dr Amber Shams. (2025). MATERNAL AND NEONATAL OUTCOMES IN HIGH-RISK OBSTETRIC PATIENTS WITH CARDIOMETABOLIC DISEASE UNDER ANESTHESIA: A SYSTEMATIC REVIEW. Journal of Population Therapeutics and Clinical Pharmacology, 32(6), 768-774. https://doi.org/10.53555/qaexnf67
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Author Biographies
Dr. Hasham Ahmed
Dr. Hasham Ahmed MBBS(KMDC) ,FCPS (IHHN)
Senior registrar creek general hospital UMDC Karachi
Dr Sanober Parveen
Dr Sanober Parveen MBBS, Liaquat University of Medical and Health
Sciences, Jamshoro, Pakistan FCPS in obstetrics and gynaecolog
Dr Ali Akram Khan
Dr Ali Akram Khan M.B.B.S ( University Of Karachi)
FCPS Anesthesiology
Dr Ayesha Tanveer
Dr Ayesha Tanveer M.B.B.S (University of Karachi)
Dr Bakhtawar
Dr Bakhtawar MBBS ,FCPS consultant obstetrics and gynaecology Jahlawan
teaching hospital khuzdar
Dr Misbah
Dr Misbah MBBS,Peoples university of medical and health sciences for women
Dr Amber Shams
MBBS, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan Professional Diploma in Gynaecology & Obstetrics, Royal College of Physicians of Ireland (RCPI).
How to Cite
Dr. Hasham Ahmed, Dr Sanober Parveen, Dr Ali Akram Khan, Dr Ayesha Tanveer, Dr Bakhtawar, Dr Misbah, & Dr Amber Shams. (2025). MATERNAL AND NEONATAL OUTCOMES IN HIGH-RISK OBSTETRIC PATIENTS WITH CARDIOMETABOLIC DISEASE UNDER ANESTHESIA: A SYSTEMATIC REVIEW. Journal of Population Therapeutics and Clinical Pharmacology, 32(6), 768-774. https://doi.org/10.53555/qaexnf67