(17) Antenatal Experiences of Pregnant Women with Cardiac Conditions: A Systematic Review and Metasynthesis

Jasmine X. Kiley¹; Annabelle Corlett²; Emma Mitchell-Sparke^1,3; Brittany Jasper¹; Tabitha Wishlade¹; Catriona Bhagra⁴; Sara Wetzler^5,6; Catherine E. Aiken¹

1.     Department of Obstetrics and Gynaecology, University of Cambridge, Box 223, The Rosie Hospital and NIHR Cambridge Biomedical Research Centre, Cambridge CB2 0SW, United Kingdom.

2.     Department of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0SP, United Kingdom.

3.     Tufts University School of Medicine, Boston, MA, 02111, United States.

4.     Department of Cardiology, Addenbrooke’s and Royal Papworth Hospitals, Cambridge CB2 0AY, United Kingdom.

5.     Department of History and Philosophy of Science, University of Cambridge, Free School Lane, Cambridge CB2 3RH, United Kingdom.

6.     Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States.

Abstract Text:

Cardiovascular conditions are the leading cause of maternal mortality in high-income countries. Pregnancy care for these women must be carefully tailored towards improving maternal and fetal outcomes. However, there is a paucity of research examining how women experience this close monitoring. In view of the increasing number of women impacted by cardiac conditions in pregnancy, it is important to provide a framework for understanding these women’s experiences. We aim to inform supportive care that simultaneously addresses the needs of pregnant women with cardiac conditions and optimizes their pregnancy outcomes. A systematic review and meta-synthesis of first-order (patient quotations) data pertaining to the pregnancy experiences of cardio-obstetric patients was conducted. Second-order data (researcher interpretations, including themes and descriptions of findings) was used to contextualize the data and support the coding process. Searches were conducted in Medline via Ovid, Embase via Ovid, CINAHL via Ebsco, PsychINFO via Ebsco, Scopus, Web of Science Core Collection, and ASSIA via Proquest. Studies with qualitative components describing experiences of pregnant women with any cardiac condition globally were included. The Critical Appraisal Skills Programme checklist for qualitative research was employed to perform quality assessment. Inductive coding and thematic analysis were conducted using NVivo software. Thirteen qualitative studies met the inclusion criteria for meta-synthesis. We identified three key themes pertaining to the pregnancy experiences of women with cardiac conditions, including patient-provider risk perception matching, importance of communication, and peer influence. Women with established versus new cardiac diagnoses in pregnancy had differences in their experiences. Women with pre-existing cardiac conditions tended to have more confidence in their trusted providers and fewer experiences of dismissive communication. By contrast, women with newly diagnosed cardiac conditions were much more likely to experience feelings of isolation, stress, and uncertainty. Women’s feelings of insecurity and isolation were compounded by insensitive and callous communication from their providers. Depending on their own perception of risk, women noted over-medicalization or dismissal by their providers. Lastly, many women seek information, experiences, and insights from multiple sources, including support groups with lived experience, that may strongly influence how they conceptualize their risk of adverse pregnancy outcomes. Our findings about peer support through online support groups showed they could provide a sense of community and hope or induce feelings of anxiety. Congruence in patient-provider risk perception strongly influences pregnancy experience, particularly how much trust women have in their healthcare team. Whether women and their providers reach a shared understanding of risk is powerfully influenced by the quality of their communication, especially whether women felt adequately heard. Understanding how women with cardiac conditions experience pregnancy care is vital to ensure providers and services can meet women’s needs. It is paramount that providers understand the experiences of these women rather than relying solely on outcome data to inform their clinical practice. We highlight the importance of nuanced and personalized discussion about the risk of cardiac conditions during pregnancy. Finding a common ground in risk perception is critical to strengthening the patient-provider relationship and providing a basis for women to feel safe and informed during their pregnancy.