Prevalence of heart disease diagnosed de novo in pregnancy in a West London population

Abstract

Objectives To determine the prevalence of heart disease diagnosed de novo in pregnancy in a West London population and to re‐examine the current role of routine cardiovascular examination in antenatal care in the UK. Design Retrospective study. Setting Obstetric medical clinics at Queen Charlotte's and Chelsea Hospital, University College Hospital and Northwick Park Hospital. Population Three hundred and twenty women referred for cardiac evaluation during pregnancy. Results The majority of the 139 women referred specifically for evaluation of murmurs during pregnancy were found to have physiological murmurs (97%). Only four women (3%) were found to have significant cardiac lesions de novo in their pregnancy. Three of these four women were immigrants who had no previous history of heart disease. The only woman from the UK was already known to have a murmur from childhood. Conclusions Our study shows that heart disease diagnosed de novo in pregnancy in a West London population is an uncommon problem with low prevalence. It also appears to be a problem seen mainly in the immigrant population. The results emphasise the importance of taking a thorough medical history in all pregnant women. However, our results if they are confirmed, would suggest that only immigrants and those with significant symptoms or a known history of heart murmur or heart disease need undergo cardiovascular examination during pregnancy. These findings need to be confirmed in a larger group in other parts of the UK before further recommendations on selective cardiovascular examination can be made. This will have significant implications for midwifery‐led care.

Cardiac disease in pregnancy. Part 2: acquired heart disease

“…With increasing immigration from countries where rheumatic fever remains prevalent, valvular heart disease is set to become a significant problem. In this context, valvular heart disease is often first recognised during pregnancy, when increased demands on the heart trigger symptoms 4 . Although rare, ischaemic heart disease is increasing in pregnancy.…”

Pregnancy and non-valvular heart disease - Anesthetic considerations

“…[1][2][3] In the developed world, congenital heart disease has supplanted rheumatic heart disease as the major cause of cardiac disease in pregnancy because, with the improvement in outcome in surgery for congenital heart anomalies, patients are increasingly likely to survive up to the child-bearing age. [4] Counseling of women with cardiac diseases is best performed prior to conception.…”

Cardiac disease in pregnancy – A retrospective study

“…3,4 At present cardiac disorders complicate approximately 1% to 3% of all pregnancies. 7 The disease profile, whether it is congenital, rheumatic, or ischemic heart disease, depends on the population seen. 7 Although rheumatic heart disease is still prevalent in developing countries, where it is responsible for as much as 90% of heart disease in pregnancy, it is now less frequent in developed countries.…”

“…7 The disease profile, whether it is congenital, rheumatic, or ischemic heart disease, depends on the population seen. 7 Although rheumatic heart disease is still prevalent in developing countries, where it is responsible for as much as 90% of heart disease in pregnancy, it is now less frequent in developed countries. 6 In developing countries with a higher prevalence of rheumatic fever it may complicate as many as 5.9% ofpregnancies.…”