Background
In Australia, First Nations women of childbearing age experience the highest burden of rheumatic heart disease (RHD). This study quantifies the impact of pregnancy on risk of developing cardiovascular complications for Australian women with RHD, 2010–2017, using the 2023 World Heart Federation (WHF) guidelines for the echocardiographic diagnosis of RHD as a framework.
Methods
Linked RHD register, hospital, death and midwives’ data from Western Australia, Northern Territory, South Australia and New South Wales were used to measure cardiovascular risk in 12–44-year-old pregnant women with RHD. The probability of hospitalisation for new cardiovascular complications was measured using mixed effects Cox regression and compared by RHD stage and pregnancy status.
Outcomes
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 4.5% of Stage B/C and 31.8% of Stage D women experienced cardiovascular complications. The risk of cardiovascular complications was five- to 10-fold higher during pregnancy than non-pregnancy and did not differ by RHD stage. First-ever RHD diagnosis during pregnancy was strongly associated with complications.
Implications for practice
Findings highlight the importance of clinician education about the 2023 WHF guidelines to inform care. Culturally safe cardio-obstetric and primary care services and continuity of care remain a priority for women with RHD.
Conclusions
Women with RHD experienced heightened cardiovascular complication risks during pregnancy in alignment with WHF staging guidelines. First-ever RHD diagnosis during pregnancy represents a special high-risk group.