The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high-income setting

a prospective cohort study

E. A. Sullivan, G. Vaughan, Z. Li, M. J. Peek, J. R. Carapetis, W. Walsh, J. Frawley, M. G.W. Rémond, B. Remenyi, L. Jackson Pulver, S. Kruske, S. Belton, C. McLintock

    Research output: Contribution to journalArticleResearchpeer-review

    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 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 abstract: Rheumatic heart disease in pregnancy persists in First Nations people in Australia and New Zealand and is associated with major cardiac and perinatal morbidity.

    Original languageEnglish
    Pages (from-to)1-10
    Number of pages10
    JournalBJOG: an International Journal of Obstetrics and Gynaecology
    DOIs
    Publication statusE-pub ahead of print - 12 Sep 2019

    Fingerprint

    Rheumatic Heart Disease
    Cohort Studies
    Prospective Studies
    Pregnancy
    Parturition
    Population
    New Zealand
    Morbidity
    Pregnant Women
    Neonatal Intensive Care
    Morus
    Maternity Hospitals
    Coronary Care Units
    Stillbirth
    Perinatal Mortality
    Vulnerable Populations
    Postpartum Period
    Intensive Care Units
    Counseling
    Epidemiology

    Cite this

    Sullivan, E. A. ; Vaughan, G. ; Li, Z. ; Peek, M. J. ; Carapetis, J. R. ; Walsh, W. ; Frawley, J. ; Rémond, M. G.W. ; Remenyi, B. ; Jackson Pulver, L. ; Kruske, S. ; Belton, S. ; McLintock, C. / The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high-income setting : a prospective cohort study. In: BJOG: an International Journal of Obstetrics and Gynaecology. 2019 ; pp. 1-10.
    @article{4d83cf35587044e6a4582d4693a9a73e,
    title = "The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high-income setting: a prospective cohort study",
    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 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 abstract: Rheumatic heart disease in pregnancy persists in First Nations people in Australia and New Zealand and is associated with major cardiac and perinatal morbidity.",
    keywords = "First Nations, maternal health, perinatal outcomes, rheumatic heart disease, stillbirth",
    author = "Sullivan, {E. A.} and G. Vaughan and Z. Li and Peek, {M. J.} and Carapetis, {J. R.} and W. Walsh and J. Frawley and R{\'e}mond, {M. G.W.} and B. Remenyi and {Jackson Pulver}, L. and S. Kruske and S. Belton and C. McLintock",
    year = "2019",
    month = "9",
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    doi = "10.1111/1471-0528.15938",
    language = "English",
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    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 2019, 'The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high-income setting: a prospective cohort study', BJOG: an International Journal of Obstetrics and Gynaecology, pp. 1-10. https://doi.org/10.1111/1471-0528.15938

    The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high-income setting : a prospective cohort study. / Sullivan, E. A.; Vaughan, G.; Li, Z.; Peek, M. J.; Carapetis, J. R.; Walsh, W.; Frawley, J.; Rémond, M. G.W.; Remenyi, B.; Jackson Pulver, L.; Kruske, S.; Belton, S.; McLintock, C.

    In: BJOG: an International Journal of Obstetrics and Gynaecology, 12.09.2019, p. 1-10.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high-income setting

    T2 - a prospective cohort study

    AU - Sullivan, E. A.

    AU - Vaughan, G.

    AU - Li, Z.

    AU - Peek, M. J.

    AU - Carapetis, J. R.

    AU - Walsh, W.

    AU - Frawley, J.

    AU - Rémond, M. G.W.

    AU - Remenyi, B.

    AU - Jackson Pulver, L.

    AU - Kruske, S.

    AU - Belton, S.

    AU - McLintock, C.

    PY - 2019/9/12

    Y1 - 2019/9/12

    N2 - 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 abstract: Rheumatic heart disease in pregnancy persists in First Nations people in Australia and New Zealand and is associated with major cardiac and perinatal morbidity.

    AB - 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 abstract: Rheumatic heart disease in pregnancy persists in First Nations people in Australia and New Zealand and is associated with major cardiac and perinatal morbidity.

    KW - First Nations

    KW - maternal health

    KW - perinatal outcomes

    KW - rheumatic heart disease

    KW - stillbirth

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    DO - 10.1111/1471-0528.15938

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    JO - BJOG: an International Journal of Obstetrics and Gynaecology

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