Global Disparities in Outcomes of Pregnant Individuals With Rheumatic Heart Disease: A Scoping Review

Jenny M Yang; Natalie Tchakerian; Candice K Silversides; Samuel C Siu; Rachel F Spitzer; Wycliffe Kosgei; Nanette Okun; Rebecca Lumsden; Rohan D'Souza; Anish Keepanasseril

doi:10.1016/j.jacadv.2024.101368

Global Disparities in Outcomes of Pregnant Individuals With Rheumatic Heart Disease: A Scoping Review

JACC Adv. 2024 Oct 30;3(12):101368. doi: 10.1016/j.jacadv.2024.101368. eCollection 2024 Dec.

Authors

Jenny M Yang^{1

2}, Natalie Tchakerian³, Candice K Silversides⁴, Samuel C Siu⁵, Rachel F Spitzer^{1

6}, Wycliffe Kosgei⁷, Nanette Okun⁸, Rebecca Lumsden⁹, Rohan D'Souza¹⁰, Anish Keepanasseril¹¹

Affiliations

¹ Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.
² Department of Obstetrics and Gynaecology, Liverpool Hospital, Sydney, New South Wales, Australia.
³ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁴ Division of Cardiology, Miles Nadal Heart Centre, Mount Sinai Hospital and Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
⁵ Division of Cardiology, University of Western Ontario, London, Ontario, Canada.
⁶ Section of Gynaecology, Division of Endocrinology, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
⁷ Department of Obstetrics and Gynaecology, Moi Teaching and Referral Hospital, Eldoret, Kenya.
⁸ Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Hospital, Toronto, Ontario, Canada.
⁹ Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
¹⁰ Departments of Obstetrics and Gynaecology and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
¹¹ Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Abstract

Background: Rheumatic heart disease (RHD) remains as 1 of the major contributors to indirect pregnancy-related mortality and morbidity worldwide and disproportionately affects marginalized populations.

Objectives: In this scoping review, the authors sought to explore the socioeconomic, cultural, and health care access-related causes of global disparities in outcomes of pregnancy among individuals with RHD.

Methods: We performed a literature search of all studies published between January 1, 1990, and January 1, 2022, that investigated causes for disparate outcomes in pregnant individuals with RHD.

Results: Of the 3,544 articles identified, 16 were included in the final analysis. The key reasons for disparate outcomes included lack of secondary antibiotic RHD prophylaxis; late and more severe RHD diagnosis, differences in management and antenatal care access; lack of expert and coordinated multidisciplinary care; suboptimal patient health education; inadequate access to RHD medication, intervention and surgery in pregnancy; and limited financial and economic resources.

Conclusions: These findings illustrated using a life-course approach demonstrate opportunities for clinical and public health interventions to improve outcomes in this population.

Keywords: cardio-obstetrics; cardiovascular diseases and pregnancy; global health; global women’s health; maternal mortality; rheumatic heart disease.