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Cardiac and Obstetric Complications of Pregnant Women with Rheumatic Heart Disease in Sub-Saharan Africa: A Systematic Review Cover

Cardiac and Obstetric Complications of Pregnant Women with Rheumatic Heart Disease in Sub-Saharan Africa: A Systematic Review

Open Access
|Jan 2026

References

  1. World Health Organization. Rheumatic heart disease [Internet]. World Health Organization [cited 2018 May 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/rheumatic-heart-disease
  2. Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. The Lancet Infectious Diseases. 2005;5(11):685694. DOI: 10.1016/S1473-3099(05)70267-X
  3. Yuyun MF, Sliwa K, Kengne AP, Mocumbi AO, Bukhman G. Cardiovascular diseases in sub-Saharan Africa compared to high-income countries: An epidemiological perspective. 2020;15(1):15. DOI: 10.5334/gh.403
  4. Woldu B, Bloomfield GS. Rheumatic heart disease in the twenty-first century. Current Cardiology Reports. 2016;18(10):96. DOI: 10.1007/s11886-016-0773-2
  5. Watkins DA, Johnson CO, Colquhoun SM, et al. Global, regional, and national burden of rheumatic heart disease, 1990–2015. New England Journal of Medicine. 2017;377(8):713722. DOI: 10.1056/NEJMoa1603693
  6. Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019. Journal of the American College of Cardiology. 2020;76(25):29823021. DOI: 10.1016/j.jacc.2020.11.010
  7. Ghamari S, Abbasi-Kangevari M, Saeedi Moghaddam S, et al. Rheumatic heart disease is a neglected disease relative to its burden worldwide: Findings from global burden of disease 2019. Journal of the American Heart Association. 2022;11(13):e025284. DOI: 10.1161/JAHA.122.025284
  8. Zühlke L, Engel ME, Karthikeyan G, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: The Global Rheumatic Heart Disease Registry (the REMEDY study). European Heart Journal. 2015;36(18):11151122. DOI: 10.1093/eurheartj/ehu449
  9. Lumsden RH, Akwanalo C, Chepkwony S, et al. Clinical and geographic patterns of rheumatic heart disease in outpatients attending cardiology clinic in western Kenya. International Journal of Cardiology. 2016;223:228235. DOI: 10.1016/j.ijcard.2016.08.069
  10. Eberly LA, Rusingiza E, Park PH, et al. Understanding the etiology of Heart Failure among the rural poor in sub-Saharan Africa: A 10-year experience from district hospitals in Rwanda. Journal of Cardiac Failure. 2018;24(12):849853. DOI: 10.1016/j.cardfail.2018.10.002
  11. Sliwa K, Carrington M, Mayosi BM, Zigiriadis E, Mvungi R, Stewart S. Incidence and characteristics of newly diagnosed rheumatic heart disease in Urban African adults: insights from the Heart of Soweto Study. European Heart Journal. 2010;31(6):719727. DOI: 10.1093/eurheartj/ehp530
  12. Goldstein SA, Ward CC. Congenital and acquired valvular heart disease in pregnancy. Current Cardiology Reports. 2017;19(10):96. DOI: 10.1007/s11886-017-0910-6
  13. Lewey J, Andrade L, Levine LD. Valvular Heart Disease in Pregnancy. Cardiology Clinics. 2021;39(1):151161. ISSN 0733-8651, ISBN 9780323809269. DOI: 10.1016/j.ccl.2020.09.010 (https://www.sciencedirect.com/science/article/pii/S0733865120300874).
  14. Carapetis JR, Beaton A, Cunningham MW, et al. Acute rheumatic fever and rheumatic heart disease. Nature Reviews Disease Primers. 2016;2(1):124. DOI: 10.1038/nrdp.2015.84
  15. Anthony J, Osman A, Sani M. Valvular heart disease in pregnancy. Cardiovascular Journal of Africa. 2016;27(2):111118. DOI: 10.5830/CVJA-2016-052
  16. van Hagen IM, Thorne SA, Taha N, et al. Pregnancy outcomes in women with rheumatic mitral valve disease. Circulation. 2018;137(8):806816. DOI: 10.1161/CIRCULATIONAHA.117.032561
  17. Orwat S, Diller GP, van Hagen IM, et al. Risk of pregnancy in moderate and severe aortic stenosis. Journal of the American College of Cardiology. 2016;68(16):17271737. DOI: 10.1016/j.jacc.2016.07.750
  18. Liaw J, Walker B, Hall L, Gorton S, White AV, Heal C. Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis. PLOS ONE. 2021;16(6):e0253581. DOI: 10.1371/journal.pone.0253581
  19. de Souza JAM, Martinez EE, Ambrose JA, et al. Percutaneous balloon mitral valvuloplasty in comparison with open mitral valve commissurotomy for mitral stenosis during pregnancy. Journal of the American College of Cardiology. 2001;37(3):900903. DOI: 10.1016/S0735-1097(00)01184-0
  20. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2021;143(5):e72e227. DOI: 10.1161/CIR.0000000000000923
  21. Kumar RK, Antunes MJ, Beaton A, et al. Contemporary diagnosis and management of rheumatic heart disease: Implications for closing the gap: A scientific statement from the American Heart Association. Circulation. 2020;142(20):e337e357. DOI: 10.1161/CIR.0000000000000921
  22. Vervoort D, Antunes MJ, Pezzella AT. Rheumatic heart disease: The role of global cardiac surgery. Journal of Cardiac Surgery. 2021;36(8):28572864. DOI: 10.1111/jocs.15597
  23. Yankah C, Fynn-Thompson F, Antunes M, et al. Cardiac surgery capacity in sub-Saharan Africa: Quo vadis? The Thoracic and Cardiovascular Surgeon. 2014;62(05):393401. DOI: 10.1055/s-0034-1383723
  24. Zilla P, Yacoub M, Zühlke L, et al. Global unmet needs in cardiac surgery. Global Heart. 2018;13(4):293303. DOI: 10.1016/j.gheart.2018.08.002
  25. Kurjak A, Stanojević M, Dudenhausen J. Why maternal mortality in the world remains tragedy in low-income countries and shame for high-income ones: Will sustainable development goals (SDG) help? Journal of Perinatal Medicine. 2023;51(2):170181. DOI: 10.1515/jpm-2022-0061
  26. Say L, Chou D, Gemmill A, et al. Global causes of maternal death: A WHO systematic analysis. The Lancet Global Health. 2014;2(6):e323e333. DOI: 10.1016/S2214-109X(14)70227-X
  27. Soma-Pillay P, Seabe J, Soma-Pillay P, Seabe J, Sliwa K. The importance of cardiovascular pathology contributing to maternal death: Confidential enquiry into maternal deaths in South Africa, 2011–2013. Cardiovascular Journal of Africa. 2016;27(2):60. DOI: 10.5830/CVJA-2016-008
  28. Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:n160. DOI: 10.1136/bmj.n160
  29. World Health Organizaion. Indicator metadata registry details [Internet]. World Health Organization [cited 2025 May 16]. Available from: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/4622
  30. Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, et al. Systematic reviews of etiology and risk. In: Aromataris E & Munn Z (Eds.) JBI manual for evidence synthesis. JBI; 2020. pp. 256261. Available from: https://synthesismanual.jbi.global. DOI: 10.46658/JBIRM-17-06
  31. Munn Z, Barker T, Moola S, Tufanaru C, Stern C, McArthur A, Stephenson M, et al. Methodological quality of case series studies. JBI Evidence Synthesis. 2020;18(10):21272133. DOI: 10.11124/JBISRIR-D-19-00099
  32. Nqayana T, Moodley J, Naidoo D. Cardiac disease in pregnancy. Cardiovascular Journal of Africa. 2008;19(3):145151. https://journals.co.za/doi/pdf/10.10520/EJC23125
  33. Desai DK, Adanlawo M, Naidoo DP, Moodley J, Kleinschmidt I. Mitral stenosis in pregnancy: A four-year experience at King Edward VIII Hospital, Durban, South Africa. British Journal of Obstetrics and Gynaecology. 2000;107:953958. DOI: 10.1111/j.1471-0528.2000.tb10395.x
  34. Beaton A, Okello E, Scheel A, et al. Impact of heart disease on maternal, fetal and neonatal outcomes in a low-resource setting. Heart (British Cardiac Society). 2018;105(10):755. DOI: 10.1136/heartjnl-2018-313810
  35. Roos-Hesselink J, Baris L, Johnson M, et al. Pregnancy outcomes in women with cardiovascular disease: Evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC). European Heart Journal. 2019;40(47):38483855. DOI: 10.1093/eurheartj/ehz136
  36. Ferreira VV, Monteiro AV, Moreira RI, et al. Outcomes in pregnant women with valvular heart disease from Portuguese-speaking African countries treated in Portugal through an international agreement of health cooperation. Global Heart. 2023;18(1):4. DOI: 10.5334/gh.1183
  37. Lumsden R, Barasa F, Park LP, et al. High burden of cardiac disease in pregnancy at a National Referral Hospital in western Kenya. Global Heart. 2020;15(1):10. DOI: 10.5334/gh.404
  38. Diao M. Pregnancy in women with heart disease in sub-Saharan Africa. Archives of Cardiovascular Disease. 2011;104:370374. DOI: 10.1016/j.acvd.2011.04.001
  39. Hailu A, Yeman A, Abate E, Teka H, Berhane H, Whe A. Management and outcome of severe pulmonary hypertension in pregnancy: Experience from a university hospital in northern Ethiopia. Ethiopian Medical Journal. 2019;57(2):203210. https://scispace.com/pdf/management-and-outcome-of-pulmonary-hypertension-in-2qg0ufqbbm.pdf
  40. Poli PA, Orang’o EO, Mwangi A, Barasa FA. Factors related to maternal adverse outcomes in pregnant women with cardiac disease in low-resource settings. European Cardiology Review. 2020;15(e68). DOI: 10.15420/ecr.2020.04
  41. Soma-Pillay P, MacDonald AP, Mathivha TM, Bakker JL, Mackintosh MO. Cardiac disease in pregnancy: a 4-year audit at Pretoria Academic Hospital. South African Medical Journal. 2008;98(7):553556.
  42. Sliwa K, Azibani F, Baard J, et al. Reducing late maternal death due to cardiovascular disease – A pragmatic pilot study. International Journal of Cardiology. 2018;272:7076. DOI: 10.1016/j.ijcard.2018.07.140
  43. Makgato C, Baloyi S, Nondabula T. Profile of cardiac patients who delivered at Universitas Academic Hospital (UAH) in Bloemfontein South Africa: 2012–2017. Obstetrics and Gynaecology Forum 2020. 30(2):2832. https://hdl.handle.net/10520/EJC-1d8e552394
  44. Heemelaar S, Petrus A, Knight M, van den Akker T. Maternal mortality due to cardiac disease in low- and middle-income countries. Tropical Medicine and International Health. 2020;25(6):673686. DOI: 10.1111/tmi.13386
  45. Greeff N, Langenegger E, Herbst P, Lombard C, Theron A. Disease spectrum and short-term outcomes of obstetric patients with cardiac disease admitted to an obstetric critical care unit in South Africa. Southern African Journal of Anaesthesia and Analgesia. 2024;30(5):a1236. DOI: 10.36303/SAJAA.3120
  46. Balieva I, Voors AA, Balieva I, et al. Pregnancy in women with cardiac disease: a one-year retrospective review of management and maternal and neonatal outcomes in a tertiary hospital in Johannesburg, South Africa. Cardiovascular Journal of Africa. 2021;32(6):301. DOI: 10.5830/CVJA-2020-062
  47. Gebremedhin Y, Guteta S, Melese B, Bekele E. Predictors of maternal and fetal outcomes of pregnant women with mitral stenosis. Published online 2022. DOI: 10.1101/2022.08.04.22278407
  48. Baumgartner H, Hung J, Bermejo J, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. Journal of the American Society of Echocardiography. 2009;22(1):123. DOI: 10.1016/j.echo.2008.11.029
  49. Shrestha P, Kuikel S, Bajracharya S, et al. Pregnancy with heart disease in South Asia: A systematic review and meta-analysis of prevalence and outcome. Annals of Medicine & Surgery. 2022;80:104293. DOI: 10.1016/j.amsu.2022.104293
  50. Liaw J, Walker B, Hall L, Gorton S, White AV, Heal C. Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis. PLoS ONE. 2021;16(6):e0253581. DOI: 10.1371/journal.pone.0253581
  51. Avila WS, Rossi EG, Ramires JAF, et al. Pregnancy in patients with heart disease: Experience with 1,000 cases. Clinical Cardiology. 2003;26(3):135142. DOI: 10.1002/clc.4960260308
  52. Silversides CK, Colman JM, Sermer M, Siu SC. Cardiac risk in pregnant women with rheumatic mitral stenosis. The American Journal of Cardiology. 2003;91(11):13821385. DOI: 10.1016/S0002-9149(03)00339-4
  53. Hameed A, Karaalp IS, Tummala PP, et al. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. Journal of the American College of Cardiology. 2001;37(3):893899. DOI: 10.1016/S0735-1097(00)01198-0
  54. Suri V, Sikka P, Singla R, Aggarwal N, Chopra S, Vijayvergiya R. Factors affecting the outcome of pregnancy with rheumatic heart disease: An experience from low-middle income country. Journal of Obstetrics and Gynaecology. 2019;39(8):10871092. DOI: 10.1080/01443615.2019.1587595
  55. Sethuraman D, Ramachandran N, Noorjahan S, Kanna V. Maternal and fetal outcomes in rheumatic heart disease in pregnancy. International Journal of Research in Medical Sciences. 2014;2(4):1632. DOI: 10.5455/2320-6012.ijrms20141172
  56. The Americnan College of Obstetrics & Gynecologists. Preeclampsia and pregnancy [Internet]. The American College of Obstetrics & Gynecologists; 2021 [cited 2025 June 10]. Available from: https://www.acog.org/womens-health/infographics/preeclampsia-and-pregnancy
  57. Milne ME, Clowse ME, Zhao C, Goldstein BA, Eudy AM. Impact of preeclampsia on infant and maternal health among women with rheumatic diseases. Lupus. 2024;33(4):397402. DOI: 10.1177/09612033241235870
  58. Kingué S, Ba SA, Balde D, et al. The VALVAFRIC study: A registry of rheumatic heart disease in Western and Central Africa. Archives of Cardiovascular Diseases. 2016;109(5):321329. DOI: 10.1016/j.acvd.2015.12.004
  59. Seitler S, Ahmad M, Ahuja SAC, et al. Routine antenatal echocardiography in high-prevalence areas of rheumatic heart disease: A WHO-guideline systematic review. Global Heart. 2024;19(1):39. DOI: 10.5334/gh.1318
  60. Justin Paul G, Anne Princy S, Jeemon P. Routine antenatal echocardiography in low- and Middle-Income Countries. JACC: Advances. 2024;3(12, Part 2):101334. DOI: 10.1016/j.jacadv.2024.101334
  61. Chillo P, Mutagaywa R, Nkya D, et al. Sub-clinical rheumatic heart disease (RHD) detected by hand-held echocardiogram in children participating in a school-based RHD prevention program in Tanzania. BMC Cardiovascular Disorders. 2023;23(1):155. DOI: 10.1186/s12872-023-03186-y
  62. Nkoke C, Lekoubou A, Dzudie A, et al. Echocardiographic pattern of rheumatic valvular disease in a contemporary sub-Saharan African pediatric population: An audit of a major cardiac ultrasound unit in Yaounde, Cameroon. BMC Pediatrics. 2016;16:43. DOI: 10.1186/s12887-016-0584-z
  63. Sims Sanyahumbi A, Sable CA, Beaton A, et al. School and community screening shows Malawi, Africa, to have a high prevalence of latent rheumatic heart disease. Congenital Heart Disease. 2016;11(6):615621. DOI: 10.1111/chd.12353
  64. Beaton A, Lu JC, Aliku T, et al. The utility of handheld echocardiography for early rheumatic heart disease diagnosis: A field study. European Heart Journal – Cardiovascular Imaging. 2015;16(5):475482. DOI: 10.1093/ehjci/jeu296
  65. Paulo DG, Mutagaywa R, Mayala H, Barongo A. Pregnancy risk and contraception among reproductive-age women with rheumatic heart disease attending care at a tertiary cardiac center in Tanzania: A hospital-based cross-sectional study. BMC Women’s Health. 2023;23:404. DOI: 10.1186/s12905-023-02332-0
  66. Voleti S, Okello E, Murali M, et al. The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: A prospective follow up study. BMC Pregnancy and Childbirth. 2020;20(1):611. DOI: 10.1186/s12884-020-03189-z
  67. Fletcher R, Forbes F, Dadi AF, et al. Effect of male partners’ involvement and support on reproductive, maternal and child health and well-being in East Africa: A scoping review. Health Science Reports. 2024;7(8):e2269. DOI: 10.1002/hsr2.2269
  68. Watkins D, Zuhlke L, Engel M, et al. Seven key actions to eradicate rheumatic heart disease in Africa: The Addis Ababa communiqué. The Cardiovascular Journal of Africa. 2016;27(3):184187. DOI: 10.5830/CVJA-2015-090
  69. Vera Vaz Ferreira MD, Endale Tefera MD, Oketcho Micheal MD, et al. Cardiac Surgery in Sub-Saharan Africa: Anthills of the Savannah. JACC: Advances. 2025;4(1). DOI: 10.1016/j.jacadv.2024.101223
  70. Effiom VB, Michael AJ, Ahmed FK, et al. Cardiothoracic surgery training in Africa: History and developments. JTCVS Open. 2024;19:370377. DOI: 10.1016/j.xjon.2024.03.005
  71. van Hagen IM, Boersma E, Johnson MR, et al. Global cardiac risk assessment in the Registry Of Pregnancy And Cardiac disease: Results of a registry from the European Society of Cardiology. European Journal of Heart Failure. 2016;18(5):523533. DOI: 10.1002/ejhf.501
DOI: https://doi.org/10.5334/gh.1522 | Journal eISSN: 2211-8179
Language: English
Submitted on: Aug 29, 2025
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Accepted on: Jan 14, 2026
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Published on: Jan 30, 2026
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year

© 2026 Evangelia Alexopoulos, Doreen Nakagaayi, Elizabeth R. Blackwood, Felix Barasa, Joan Kiyeng, Wycliffe Kosgei, G. Titus Ng’eno, Shanti Nulu, Rebecca Lumsden, Andrea Beaton, Gerald S. Bloomfield, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.