Epidemiology of Rheumatic Heart Disease in Pregnancy in ANZ

Abstract

Background: Rheumatic heart disease (RHD) in pregnancy is associated with significant maternal morbidity and mortality. We describe the epidemiology of RHD in pregnancy in Australia and New Zealand (ANZ). Methods: A population-based cohort study of pregnant women with RHD recruited 2013-14 through the hospital-based Australasian Maternity Outcomes Surveillance System. Findings: There were 311 cases of RHD in pregnancy - 266 (86%) identified as First Nations. Prevalence was highest in Aboriginal women in the NT (2.22%). MR was present in 269 cases (86%), MS in 116 (37%). Fifty (16%) cases had a prior cardiac intervention - 13 valve replacement, 22 repair, 15 PBMV. Fourteen percent of cases had a cardiac visit before 14 weeks, 9% between 14–19 weeks, 42% ≥ 20 weeks. A third of cases did not visit a cardiac specialist. Forty-five (15%) cases had no echocardiogram during pregnancy/postpartum; 39 (13%) were diagnosed with RHD during pregnancy/postpartum. There was one maternal death (case fatality rate = 0·3%). 32% were admitted to intensive/higher care units during pregnancy and 19% postpartum. 314 babies were born with seven stillbirths (22·3/1,000), three to women taking anticoagulants, and two neonatal deaths (6·5/1,000). Twenty-one percent of neonates were preterm, 19% had low birthweights. Conclusion: In ANZ, RHD in pregnancy persists among First Nations populations. It remains a disease of inequity. Despite significant cardiac and perinatal morbidity, high quality tertiary health care minimised mortality. There is a need to build upon care provided in pregnancy so as to provide long-term chronic disease management for women with RHD.