Characteristics of pregnant women with cardiac disease delivering at a tertiary hospital in Lusaka

Abstract

Cardiac disease complicates 0.2-4% of all pregnancies in western countries with 53 countries showing increasing trends in high-risk cardiac related pregnancies from 0.7% (2007-2010) to 10.9% (2015 -2018). The mean prevalence of heart disease in pregnancy is 616 per 100, 000 deliveries with a four-fold increase in mortality in South Africa as an exemplar. Cardiac disease has effects on neonatal outcomes such as prematurity, growth restriction, birth asphyxia and foetal demise. In Zambia, 10% of deaths due to noncommunicable diseases within the general population are cardiovascular related. However there is paucity of data indicating the prevalence and clinical trajectory of cardiac disease in pregnancy. Therefore, we aimed to understand obstetric characteristics and neonatal outcomes of pregnant women with cardiac disease presenting to the Women and Newborn hospital in Lusaka, Zambia We conducted a comprehensive retrospective review of obstetrics records for a 15-year period (2004 to 2019) for all deliveries that occurred at the Women and Newborn Hospital. The hospital serves as the largest referral centre for the country and located within the capital city, Lusaka. Data was collected using a pretested data collection chart. We performed descriptive statistics and reported results as frequencies or medians with corresponding interquartile ranges. We identified 349 pregnancies. The prevalence of cardiac disease in pregnancy was 0.14% with a general uptrend in cases per year. The average age was 29 years SD 6years, median parity was 3 (IQR 1-4), median gestation age at delivery was 38 weeks (IQR 36-39), the commonest mode of delivery was vaginal (82.85 vs 17.15), with a about a quarter having instrumental deliveries, median neonates birth weight was 3kg IQR (2.6 -3.3). Overall, most babies were born in good condition (94.34% vs 5.66%) with an APGAR score of 9 for most infants.Cardiac disease in pregnancy is common in Zambia. Healthcare providers need to be abreast with guidelines on preconceptual, antenatal and postnatal management of women with cardiac disease to enhance favorable outcomes.