Prevalence and patterns of Cardiovascular Diseases among Pregnant Mothers
Prevalence and patterns of Cardiovascular Diseases among Pregnant Mothers Attending Antenatal care at Saint Paul’s Hospital Millennium Medical College, Addis Ababa
Back ground: Cardiovascular disease (CVD) is one of the leading causes of non-obstetric maternal death during pregnancy. There are limited number of studies done to assess the prevalence of CVD during pregnancy in our set up.
Objectives: To describe the prevalence and patterns of cardiovascular diseases among pregnant women attending ANC follow up at St Paul’s hospital
Methods: A total of 398 pregnant mothers who were on follow up at ANC clinic were randomly selected for clinical and echocardiographic evaluation in their 3rd trimester of pregnancy. Standard echocardiography was done for all of them by using GE Vivid E9 echocardiography machine.
Results: In general 10.3% (n=41) pregnant mothers had cardiovascular disease with clinical evaluation and echocardiography. Thirty-three (8.3 %) of the mothers have at least one echocardiographic abnormality out of which 2.3% (n=9) had significant rheumatic valvular heart disease. Four (1.0%) of the mothers have moderate-severe pulmonary hypertension.
Conclusion: The study revealed a fairly high prevalence of rheumatic heart disease among pregnant mothers in our set up. Primary care providers of pregnant mothers at ANC should be vigilant in their clinical evaluation to detect such problems in a timely manner.
 Department of Internal Medicine, Saint Paul’s Hospital Millennium Medical College
 Department of Obstetrics and Gynecology, Saint Paul’s Hospital Millennium Medical College
Hunter S, Robson SC. Adaptation of the maternal heart in pregnancy. Br Heart J 1992;68: 540–543.
Clapp JF III, Capeless E. Cardiovascular function before, during, and after the first and subsequent pregnancies. Am J Cardiol 1997; 80:1469–1473
Savu O, Jurcut R, Giusca S, van MieghemT, Gussi I, Popescu BA et al. Circ Cardiovasc Imaging 2012; 5:289-297.
Elkayam U, Bitar F. Valvular heart disease and pregnancy part I: native valves. J Am Coll Cardiol. 2005; 46:223–230
Cornette J, Roos-Hesselink JW. Normal cardiovascular adaptation to pregnancy. Chapter 29. In: Stergiopoulos K, Brown D, eds. Evidence Based Cardiology Consult. London: Springer; 2013:423–432
Peters RM, Flack JM. Hypertensive disorders of pregnancy. J Obstet Gynecol Neonatal Nurs 2004; 33:209–220
Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet 2007; 370: 1929–1938.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, EzzatiMet al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2163–2196
Saving Mothers' Lives. Reviewing maternal deaths to make motherhood safer: 2006-2008; Centre for Maternal and Child Enquiries (CMACE), BJOG, Mar 2011
Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: The Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011; 32:3147–3197
Seely EW, Ecker J. Clinical practice. Chronic hypertension in pregnancy. N Engl J Med 2011; 365:439-446.
Fett JD, Carraway RD, Dowell DL, King ME, Pierre R. Peripartum cardiomyopathy in the Hospital Albert Schweitzer District of Haiti. Am J Obstet Gynecol 2002; 186:1005–1010
Fett JD, Christie LG, Carraway RD, Ansari AA, Sundstrom JB, Murphy JG. Unrecognized peripartum cardiomyopathy in Haitian women. Int J Gynaecol Obstet 2005; 90:161–166.
Desai D, Moodley J, Naidoo D. Peripartum cardiomyopathy: experiences at King Edward VIII Hospital, Durban, South Africa and a review of the literature. Trop Doct 1995; 25:118–123.
Chapa JB, Heiberger HB, Weinert L, Decara J, Lang RM, Hibbard JU. Prognostic value of echocardiography in peripartum cardiomyopathy. Obstet Gynecol 2005; 105:1303–1308.
Brar SS, Khan SS, Sandhu GK, Jorgensen MB, Parikh N, Hsu JWet al. Incidence, mortality, and racial
DeMaio SJ Jr, Kinsella SH, Silverman ME. Clinical course and long-term prognosis of spontaneous coronary artery dissection. Am J Cardiol 1989; 64:471–474.
Mather PJ, Hansen CL, Goldman B, Inniss S, Pina I, Norris R.et al. Post-partum multivessel coronary dissection. J Heart Lung Transplant 1994; 13:533–537
Stangl V, Schad J, Gossing G, Borges A, Baumann G, Stangl K. Maternal heart disease and pregnancy outcome: a single-centre experience. Eur J Heart Fail 2008; 10:855–860
James AH, Jamison MG, Biswas MS, Brancazio LR, Swamy GK, Myers ER. Acute myocardial infarction in pregnancy: a United States population-based study. Circulation 2006; 113:1564–1571
Head CE, Thorne SA; Congenital heart disease in pregnancy. Postgrad Med J. 2005 May; 81(955):2928.
Cardiac Disease and Pregnancy; Royal College of Obstetricians and Gynecologists (June 2011)
Pieper PG, Balci A, Van Dijk AP; Pregnancy in women with prosthetic heart valves. Neth Heart J. 2008 Dec; 16(12):406-11
Akhtar RP, Abid AR, Zafar H, et al; Anticoagulation in pregnancy with mechanical heart valves: 10-year experience. Asian Cardiovasc Thorac Ann. 2007 Dec; 15 (6):497-501.
Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, Kells CM, Bergin ML, Kiess MC, Marcotte F, Taylor DA, Gordon EP, Spears JC, Tam JW, Amankwah KS, Smallhorn JF, Farine D, Sorensen S. Circulation 2001; 104:515–521.
Sliwa K, Bohm M, Cardiovascular Res R2014 Mar 15; 101(4):554-60. doi:10.1093/cvr/cvu012. Epub 2014 Jan 23
The Journal of Obstetrics and Gynecology of India (May–June 2012) 62(3):301–306
H°avard Otto, Sverre Georg Sæther, Leul Banteyrga, Bjørn Olav Haugen, Terje Skjærpe,et.al, J. echocardiography (2011), vol (10) 1049- 1053, DOI: 10.1111/j.1540 8175.2011.01520
P Soma-Pillay, A P Macdonald, T M Mathivha, J L Bakker, M O Mackintosh, S Afr Med J 2008; 98:553-556.
European heart journal advance access published April 29,2015
Reményi, B. et al. Nat. Rev. Cardiol. advance online publication 28 February 2012
Karen silwa and Michael Bohm et.al cardiovascular research, volume 101, issue 4. march 2014,554-560
Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal disease. Lancet Infect Dis. 2005; 5:685–694
Marijon E, Ou P, Celermajer DS, Ferreira B, Mocumbi AO, Jani D, Paquet C, Jacob S, Sidi D, Jouven X. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med. 2007; 357:470–476.
Roos-Hesselink JW, Ruys TP, Stein JI, Thilen U, Webb GD, Niwa K, Kaemmerer H, Baumgartner H, Budts W, Maggioni AP, Tavazzi L, Taha N, Johnson MR, Hall R, results of a registry of the European Society of Cardiology. Eur Heart J. 2013; 34:657–665.
Harvard Otto.et al High Prevalence of Subclinical Rheumatic Heart Disease in Pregnant Women in a Developing Country, J. echocardiography. 1540-8175.2011
Bhaya M, Panwar S, Beniwal R, et al: High prevalence of rheumatic heart disease detected by echocardiography in school children. Echocardiography 2010; 27:448–453
Marijon E, Ou P, Celermajer DS, et al: Prevalence of rheumatic heart disease detected by echocardiographic Screening. N Engl J Med 2007; 357:470–476
Carapetis JR, Hardy M, Fakakovikaetau T, et al: Evaluation of a screening protocol using auscultation and portable echocardiography to detect asymptomatic rheumatic heart disease in Tongan schoolchildren. Nat Clin Prac Cardiovasc Med 2008; 5:411–417.
Sadiq M, Islam K, Abid R, et al: Prevalence of Rheumatic Heart Disease in School Children of Urban Lahore. Heart 2009; 95:353–357
Oli K, et al: east African medical journal 76(11):601-5 November 1999
Yadeta D, et al.int J cardiol.2016
Irizarry OC, Levine LD, Lewey JJ, et al. JAMA Cardiol. 2017; 10.1001/jamacardio.2017.3574
Ristic AD, et al. Herz.2003 May; 28 (3):209-15.