Article Text

Download PDFPDF
Original research article
Impact of heart disease on maternal, fetal and neonatal outcomes in a low-resource setting
  1. Andrea Beaton1,2,
  2. Emmy Okello3,
  3. Amy Scheel4,
  4. Alyssa DeWyer4,
  5. Renny Ssembatya5,
  6. Olivia Baaka5,
  7. Henrietor Namisanvu5,
  8. Angela Njeri5,6,
  9. Alphons Matovu6,
  10. Imelda Namagembe7,
  11. Robert Mccarter4,
  12. Jonathan Carapetis8,
  13. Kristen DeStigter9,
  14. Craig Sable4
  1. 1 Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
  3. 3 The Uganda Heart Institute, Kampala, Uganda
  4. 4 Children’s National Medical Center, Washington DC, USA
  5. 5 Imaging the World Africa, Kampala, Uganda
  6. 6 Mubende Regional Referral Hospital, Mubende, Uganda
  7. 7 Mulago National Referral Hospital, Kampala, Uganda
  8. 8 Telethon Kids Institute, Nedlands, Western Australia, Australia
  9. 9 University of Vermont Medical Center, Burlington, Vermont, USA
  1. Correspondence to Dr Andrea Beaton, Department of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH 45229, USA; ABeaton{at}


Background The burden of pre-existing cardiovascular disease and the contribution to adverse pregnancy outcomes are not robustly quantified, particularly in low-income countries. We aimed to determine both the prevalence of maternal heart disease through active case finding and its attributable risk to adverse pregnancy outcomes.

Methods We conducted a 24-month prospective longitudinal investigation in three Ugandan health centres, using echocardiography for active case finding during antenatal care. Women with and without heart disease were followed to 6 weeks post partum to determine pregnancy outcomes. Prevalence of heart disease was calculated. Per cent attributable risk estimates were generated for maternal, fetal and neonatal mortality.

Results Screening echocardiography was performed in 3506 women. The prevalence of heart disease was 17 per 1000 women (95% CI 13 to 21); 15 per 1000 was rheumatic heart disease. Only 3.4% of women (2/58) had prior diagnosis. Cardiovascular complications occurred in 51% of women with heart disease, most commonly heart failure. Per cent attributable risk of heart disease on maternal mortality was 88.6% in the exposed population and 10.8% in the overall population. Population attributable risk of heart disease on fetal death was 1.1% and 6.0% for neonatal mortality

Conclusions Occult maternal heart disease may be responsible for a substantial proportion of adverse pregnancy outcomes in low-resource settings. Rheumatic heart disease is, by far, the most common condition, urging global prioritisation of this neglected cardiovascular disease.

  • valvular heart disease
  • pregnancy
  • global health

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors All of the authors contributed to one or more of the following: conception or design of the work (AB, EO, AS, IN, KD, CS), data collection (AS, AD, RS, OB, HN, AN, AM), data analysis and interpretation (AB, RM, JC), drafting the article (AB) and critical revision of the article (all). All authors provided final approval of the version to be published.

  • Funding The work was funded by the American Heart Association Mentored Clinical and Population Award (15MCPRP25090076), the Children’s Research Institute and private donors to Children’s National Medical Center Africa Fund.

  • Disclaimer The funders had no role in study design; data collection, analysis, interpretation; or writing the report. The corresponding author had full access to all the data in the study and final responsibility for the decision to submit for publication.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Mengo Institutional Review Board and Children’s National Medical Center Institutional Review Board as well as the Uganda National Council of Science and Technology.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice Since this paper was first published online, changes have been made to the author affiliations.