Background
Rheumatic heart disease (RHD) poses significant perinatal risks. We aimed to describe
the spectrum, severity and outcomes of rheumatic mitral valve disease in pregnancy
in Australia and New Zealand.
Methods
A prospective, population-based cohort study of pregnant women with RHD recruited
2013–14 through the hospital-based Australasian Maternity Outcomes Surveillance System.
Outcome measures included maternal and perinatal morbidity and mortality. Univariable
and multivariable logistic regression analyses were undertaken to test for predictors
of adverse maternal and perinatal outcomes.
Results
Of 274 pregnant women identified with RHD, 124 (45.3%) had mitral stenosis (MS) and
150 (54.7%) had isolated mitral regurgitation (MR). One woman with mild MS/moderate
MR died. There were six (2.2%) stillbirths and two (0.7%) neonatal deaths. Babies
born to women with MS were twice as likely to be small-for-gestational-age (22.7%
vs 11.4%, p=0.013). In women with MS, use of cardiac medication (AOR 7.42) and having
severe stenosis (AOR 16.35) were independently associated with adverse cardiac outcomes,
while New York Heart Association (NYHA) class >1 (AOR 3.94) was an independent predictor
of adverse perinatal events. In women with isolated MR, use of cardiac medications
(AOR 7.03) and use of anticoagulants (AOR 6.05) were independently associated with
adverse cardiac outcomes.
Conclusions
Careful monitoring and specialist care for women with RHD in pregnancy is required,
particularly for women with severe MS, those on cardiac medication, and those on anticoagulation,
as these are associated with increased risk of adverse maternal cardiac outcomes.
In the context of pregnancy, contraception and preconception planning are important
for young women diagnosed with RHD.
Keywords
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Article info
Publication history
Published online: November 25, 2021
Accepted:
October 21,
2021
Received in revised form:
August 16,
2021
Received:
December 21,
2020
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.