Abstract
Background:Rheumatic heart disease (RHD) in sub-Saharan Africa contributes to significant cardiac morbidity and mortality, yet prevalence estimates of RHD lesions in pregnancy are lacking.Objectives:Our first aim was to evaluate women using echocardiography to estimate the prevalence of RHD and other cardiac lesions in low-risk pregnancies. Our second aim was to assess the feasibility of screening echocardiography and its acceptability to patients.Methods:We prospectively recruited 601 pregnant women from a low-risk antenatal clinic at a tertiary care maternity centre in Western Kenya. Women completed a questionnaire about past medical history and cardiac symptoms. They underwent standardized screening echocardiography to evaluate RHD and non-RHD associated cardiac lesions. Our primary outcome was RHD-associated cardiac lesions and our secondary outcome was a composite of any clinically-relevant cardiac lesion or echocardiography finding. We also recorded duration of screening echocardiography and its acceptability among pregnant women in this sample.Results:The point prevalence of RHD-associated cardiac lesions was 5.0/1,000 (95% confidence interval: 1.0–14.5), and the point prevalence of all clinically significant lesions/findings was 21.6/1,000 (11.6–36.7). Mean screening time was seven minutes (SD 1.7, range: 4–17) for women without cardiac abnormalities and 13 minutes (SD 4.6, range: 6–23) for women with abnormal findings. Echocardiography was acceptable to women with 74.2% agreeing to participate.Conclusions:The prevalence of clinically-relevant cardiac lesions was moderately high in a low-risk population of pregnant women in Western Kenya.
Highlights
Rheumatic heart disease (RHD) is a chronic cardiac condition associated with valvular dysfunction that can significantly complicate pregnancy
Two (2) women who were enrolled withdrew after recruitment, leaving a total of 601 women (74.2%) who underwent echocardiography and who represent the sample for the analyses
This study demonstrates that screening echocardiography performed by a skilled cardiac sonographer in a low-risk antenatal population is acceptable to women
Summary
Rheumatic heart disease (RHD) is a chronic cardiac condition associated with valvular dysfunction that can significantly complicate pregnancy. Fetal and neonatal outcomes are significantly worse in pregnancies complicated by RHD with elevated risks of preterm birth, intrauterine growth restriction, low birthweight, and perinatal death [1]. RHD is no longer a significant cause of heart disease in high-income countries resulting from advances made in treating childhood streptococcal pharyngitis [3]. Rheumatic fever and its clinical sequelae disproportionately affect those living in low-income countries. Sub-Saharan Africa in particular had an estimated RHD prevalence between 4–10 cases per 1,000 in the decade leading up to 2000 and the RHDassociated mortality rate increased between 1990 and 2013 [3, 4]. Adverse outcome rates in pregnancies affected by RHD are elevated in low-income settings. A retrospective study from Senegal reported a maternal mortality rate of 34% associated with RHD along with a neonatal mortality rate above 7% [6]
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