Abstract
RHD in pregnancy (RHD-P) is associated with an increased burden of maternal and perinatal morbidity and mortality. A sequellae of rheumatic fever resulting in heart valve damage if untreated, RHD is twice as common in women. In providing an historical overview, this commentary provides context for prevention and treatment in the 21 st century.Four underlying themes inform much of the literature on RHD-P: its association with inequities; often-complex care requirements; demands for integrated care models, and a life-course approach. While there have been some gains particularly in awareness, strengthened policies and funding strategies are required to sustain improvements in the RHD landscape and consequently improve outcomes.As the principal heart disease seen in pregnant women in endemic regions, it is unlikely that the Sustainable Development Goal 3 target of reduced global maternal mortality ratio can be met by 2030 if RHD is not better addressed for women and girls.
Highlights
Rheumatic Heart Disease in PregnancyIn 2021, a young pregnant Aboriginal woman with rheumatic heart disease (RHD) was told ‘...didn’t know we had that (RHD) anymore.’ Yet this preventable disease continues to devastate Aboriginal and Torres Strait Islander communities
Four underlying themes inform much of the literature on rheumatic heart disease (RHD) in pregnancy (RHD-P): its association with inequities; often-complex care requirements; demands for integrated care models, and a life-course approach
As the principal heart disease seen in pregnant women in endemic regions, it is unlikely that the Sustainable Development Goal 3 target of reduced global maternal mortality ratio can be met by 2030 if RHD is not better addressed for women and girls
Summary
In 2021, a young pregnant Aboriginal woman with rheumatic heart disease (RHD) was told ‘...didn’t know we had that (RHD) anymore.’ Yet this preventable disease continues to devastate Aboriginal and Torres Strait Islander communities. In 2021, a young pregnant Aboriginal woman with rheumatic heart disease (RHD) was told ‘...didn’t know we had that (RHD) anymore.’. This preventable disease continues to devastate Aboriginal and Torres Strait Islander communities. A sequellae of acute rheumatic fever (ARF) that results in lasting heart valve damage if untreated [2], RHD is twice as common in women, most likely associated with several factors including increased risk of autoimmune disease, accelerated progression of mild RHD during pregnancy and increased exposure to StrepA infection. In providing an historical overview, this commentary provides context for the prevention and management in the 21st century. It considers how lessons learnt in the 19th–20th century are of relevance today. While health systems across the centuries and across the world may differ enormously according to developments in knowledge, technologies, economies, and social structures, four underlying themes inform much of the literature of RHD in pregnancy (RHD-P): the association of RHD with inequities and poverty; recognition of often-complex care requirements during pregnancy; demands for integrated care models to optimise maternal and perinatal outcomes, and a life-course approach to RHD for women and girls
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