Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease

Abstract

Objective: Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease. Methods:The Registry Of Pregnancy And Cardiac disease (ROPAC) is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, hospitalisation for cardiac reason or intervention. Associations between patient characteristics, country characteristics (income inequality expressed as Gini-coefficient, health expenditure, schooling, gross domestic product, birth rate, and hospital beds) and cardiac endpoints were checked in a three-level model (patient-centre-country).Results: A total of 30 countries enrolled 2924 patients from 89 centres. At least one endpoint occurred in 645 women (22.1%). Maternal age, New York Heart Association, and modified World Health Organization risk classification, were associated with the combined endpoint and explained 37% of variance in outcome. Ginicoefficient and country-specific birth rate explained an additional 4%. There were large differences between the individual countries, but the need for multilevel modelling to account for these differences disappeared after adjustment for patient characteristics, Gini and country specific-birth rate. Conclusion:While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome.

High Burden of Cardiac Disease in Pregnancy at a National Referral Hospital in Western Kenya

“…However, the epidemiology and outcomes associated with cardiac disease in pregnancy vary significantly between high income (HIC) and low-and middle-income countries (LMICs). Unlike in HICs where the burden of cardiac disease is primarily congenital heart disease, rheumatic heart disease (RHD) remains common in LMICs [6,15,19,20].…”

Caring for Pregnant Women with Rheumatic Heart Disease: A Qualitative Study of Health Service Provider Perspectives

“…Many aspects of the findings of our research are shared by other countries challenged by low-resources, poor access to services compounded by remoteness and lack of access to specialist services and gaps in health literacy among healthcare providers [ 18 52 53 54 55 56 57 ].…”

Predictors of maternal and neonatal complications in patients with severe valve heart disease during pregnancy: a retrospective cohort study

“…In fact, the prevalence of heart disease in pregnant women is estimated between 1 and 4% [1,2] . According to the largest multicentre registry of heart diseases in pregnant women " ROPAC", the most prevalent cardiac diseases are rheumatic valvular pathology in emerging countries and congenital heart disease in developed countries [3,4]. The World Health Organisation (WHO) considers severe stenotic valve heart disease as a contraindication to conception (WHO IV category) [5].…”