The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high‐income setting: a prospective cohort study

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...

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Published in:BJOG : an international journal of obstetrics and gynaecology Vol. 127; no. 1; pp. 47 - 56
Main Authors: Sullivan, EA, Vaughan, G, Li, Z, Peek, MJ, Carapetis, JR, Walsh, W, Frawley, J, Rémond, MGW, Remenyi, B, Jackson Pulver, L, Kruske, S, Belton, S, McLintock, C
Format: Journal Article
Language:English
Published: England Wiley Subscription Services, Inc 01.01.2020
Subjects:
Adult
Birth
Births
Body Mass Index
Cardiovascular disease
Cohort analysis
Coronary artery disease
Epidemiology
Female
First Nations
Gestation
Health risk assessment
Heart
Heart diseases
Humans
Income
Intensive care
Intensive care units
maternal health
Morbidity
Neonates
New Zealand - epidemiology
New Zealand - ethnology
Northern Territory - epidemiology
Northern Territory - ethnology
Parity
perinatal outcomes
Population studies
Postpartum
Pregnancy
Pregnancy Complications, Cardiovascular - ethnology
Prevalence
Prospective Studies
Rheumatic heart disease
Rheumatic Heart Disease - ethnology
stillbirth
Womens health
Young Adult
New Zealand
Northern Territory
Australia
stillbirth
First Nations
maternal health
perinatal outcomes
rheumatic heart disease
ISSN:1470-0328, 1471-0528, 1471-0528
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Summary: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 Māori 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. Tweetable Rheumatic heart disease in pregnancy persists in First Nations people in Australia and New Zealand and is associated with major cardiac and perinatal morbidity. Tweetable Rheumatic heart disease in pregnancy persists in First Nations people in Australia and New Zealand and is associated with major cardiac and perinatal morbidity.
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ISSN:1470-0328
1471-0528
1471-0528
DOI:10.1111/1471-0528.15938