The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high-income setting: a prospective cohort study
Date
2020
Authors
Sullivan, E A
Vaughan, Geraldine
Li, Zhuoyang
Peek, Michael
Carapetis, Jonathan R
Walsh, Warren
Frawley, J
Remond, M G W
Remenyi, B
Pulver, Lisa Jackson
Journal Title
Journal ISSN
Volume Title
Publisher
Wiley
Abstract
Objective To describe the epidemiology of rheumatic heart disease
(RHD) in pregnancy in Australia and New Zealand (A&NZ).
Design Prospective population-based study.
Setting Hospital-based maternity units throughout A&NZ.
Population Pregnant women with RHD with a birth outcome of
≥20 weeks of gestation between January 2013 and December 2014.
Methods We identified eligible women using the Australasian
Maternity Outcomes Surveillance System (AMOSS). De-identified
antenatal, perinatal and postnatal data were collected and analysed.
Main outcome measures Prevalence of RHD in pregnancy.
Perinatal morbidity and mortality. Results There were 311 pregnancies associated with women with
RHD (4.3/10 000 women giving birth, 95% CI 3.9–4.8). In
Australia, 78% were Aboriginal or Torres Strait Islander (60.4/
10 000, 95% CI 50.7–70.0), while in New Zealand 90% were
Maori or Pasifika (27.2/10 000, 95% CI 22.0–32.3). One woman
(0.3%) died and one in ten was admitted to coronary or intensive care units postpartum. There were 314 births with seven stillbirths
(22.3/1000 births) and two neonatal deaths (6.5/1000 births).
Sixty-six (21%) live-born babies were preterm and one in three
was admitted to neonatal intensive care or special care units.
Conclusion Rheumatic heart disease in pregnancy persists in
disadvantaged First Nations populations in A&NZ. It is associated
with significant cardiac and perinatal morbidity. Preconception
planning and counselling and RHD screening in at-risk pregnant
women are essential for good maternal and baby outcomes.
Description
Keywords
First Nations, maternal health, perinatal outcomes, rheumatic heart disease, stillbirth
Citation
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Source
BJOG - an international journal of Obstetrics and Gynaecology
Type
Journal article
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Restricted until
2099-12-31