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Original research article
Impact of heart disease on maternal, fetal and neonatal outcomes in a low-resource setting
  1. Andrea Beaton1,
  2. Emmy Okello2,
  3. Amy Scheel1,
  4. Alyssa DeWyer1,
  5. Renny Ssembatya3,
  6. Olivia Baaka3,
  7. Henrietor Namisanvu3,
  8. Angela Njeri3,4,
  9. Alphons Matovu3,
  10. Imelda Namagembe5,6,
  11. Robert Mccarter1,
  12. Jonathan Carapetis7,
  13. Kristen DeStigter7,
  14. Craig Sable1
  1. 1 Children’s National Medical Center, Cincinnati, Ohio, USA
  2. 2 The Uganda Heart Institute, Kampala, Uganda
  3. 3 Imaging the World Africa, Kampala, Uganda
  4. 4 Mubende Regional Referral Hospital, Mubende, Uganda
  5. 5 Mulago National Referral Hospital, Kampala, Uganda
  6. 6 Telethon Kids Institute, Nedlands, Western Australia, Australia
  7. 7 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

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  • 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.