title: Pregnancy and postpartum infective endocarditis: a systematic review.
abstract: The objective of this review was to describe the clinical characteristics, risk factors, and outcomes of infective endocarditis (IE) in pregnancy and the postpartum period. We conducted a systematic review of Ovid MEDLINE, Ovid Embase, Web of Science, and Scopus from January 1, 1988, through October 31, 2012. Included studies reported on women who met the modified Duke criteria for the diagnosis of IE and were pregnant or postpartum. We included 72 studies that described 90 cases of peripartum IE, mostly affecting native valves (92%). Risk factors associated with IE included intravenous drug use (14%), congenital heart disease (12%), and rheumatic heart disease (12%). The most common pathogens were streptococcal (43%) and staphylococcal (26%) species. Septic pulmonary, central, and other systemic emboli were common complications. Of the 51 pregnancies, there were 41 (80%) deliveries with survival to discharge, 7 (14%) fetal deaths, 1 (2%) medical termination of pregnancy, and 2 (4%) with unknown status. Maternal mortality was 11%. Infective endocarditis is a rare, life-threatening infection in pregnancy. Risk factors are changing with a marked decrease in rheumatic heart disease and an increase in intravenous drug use. The cases reported in the literature were commonly due to streptococcal organisms, involved the right-sided valves, and were associated with intravenous drug use.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN. Electronic address: kebed.kalie@mayo.edu.
authors.forename: Kalie Y
authors.initials: KY
authors.lastname: Kebed
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Kalkidan
authors.initials: K
authors.lastname: Bishu
authors.affiliation: Department of Internal Medicine, St. Joseph's Hospital, Phoenix, AZ.
authors.forename: Raed I
authors.initials: RI
authors.lastname: Al Adham
authors.affiliation: Department of Infectious Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Connolly
authors.affiliation: Department of Infectious Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Sohail
authors.affiliation: Department of Infectious Diseases, Mayo Clinic, Rochester, MN.
authors.forename: James M
authors.initials: JM
authors.lastname: Steckelberg
authors.affiliation: Department of Infectious Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Walter R
authors.initials: WR
authors.lastname: Wilson
authors.affiliation: Division of Preventive Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Murad
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Nandan S
authors.initials: NS
authors.lastname: Anavekar
mesh_terms: D000328:Adult; D004697:Endocarditis, Bacterial / Q000209:etiology / Q000382:microbiology / Q000401:mortality*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000382:microbiology; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D058725:Peripartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology / Q000382:microbiology / Q000401:mortality*; D011251:Pregnancy Complications, Infectious / Q000209:etiology / Q000382:microbiology / Q000401:mortality*; D011256:Pregnancy Outcome; D012214:Rheumatic Heart Disease / Q000150:complications / Q000382:microbiology; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000382:microbiology