Aim
In Australia, First Nations women of childbearing age experience an inequitable burden of rheumatic heart disease (RHD). This study measures cardiovascular complications including hypertension and heart failure for Australian women with RHD during pregnancy, 2010–2017, within the framework of the 2023 World Heart Federation (WHF) guidelines for the echocardiographic diagnosis of RHD.
Method
Linked RHD register, hospital, death and midwives’ data from Western Australia, Northern Territory, South Australia and New South Wales were used in a retrospective cohort study of 12–44-year-old pregnant women with RHD. Survival methods estimated the proportion and risk predictors of women with WHF Stage B/C or Stage D RHD progressing to cardiovascular complications (hypertension, heart failure, stroke, infective endocarditis, atrial fibrillation and acute pulmonary oedema).
Results
345 women with Stage B/C RHD (558 pregnancies, 95.9% First Nations, 4.4% urban) and 60 women with Stage D RHD (88 pregnancies, 83.3% First Nations, 23.3% urban) were identified. During pregnancy and up to 6 weeks post-partum, 4.5% of Stage B/C and 31.8% of Stage D women experienced cardiovascular complications. Most frequent complications were hypertension (2.2%, n=12 Stage B/C, 13.6%. n=12 Stage D) and heart failure (1.4%, n=8 Stage B/C, 9.1%, n=8, Stage D). First-ever RHD diagnosis during pregnancy was strongly associated with complications.
Conclusion
Culturally safe cardio-obstetric services and continuity of care remain a priority for women with RHD. Women with RHD experience hypertension and heart failure during pregnancy at levels proportional to WHF staging category; first-ever RHD diagnosis during pregnancy is a high-risk group.