Women, Girls And Pregnancy

Women, girls and pregnancy

Females are more at risk of developing RHD compared to males, with RHD as the most common heart disease found in pregnant women in areas where the disease is endemic.

Pregnancy causes stress to the heart and RHD can make pregnancy and delivery risky for mums and babies. Pregnant women with RHD require special care and consideration.

our RHD Screening team with an expectant mother undergoing echo treatment

Pregnancy & RHD

During any pregnancy there is an increase in blood volume of 30% – 50% resulting in increased pressure on the heart and heart valves and the work of the heart is increased by up to 50%.

Pregnancy can lead to the appearance or worsening of symptoms including shortness of breath with simple activity and waking at night out of breath. For women with more severe RHD, it could lead to the development of more serious complications. RHD in pregnancy poses a direct risk to the well-being of the woman and her fetus or newborns.

Women living with RHD need to be monitored carefully and during pregnancy by a team which may include obstetric and cardiology specialists. However, many women with RHD can have healthy pregnancies and healthy babies with the right medical care.

Some women with specific types of severe RHD may need to avoid pregnancy. Access to family planning is important to allow women and their families to make safe choices about having children.

It is important that all young women who have had ARF and RHD consider :

  • preconception counselling – as it provides an opportunity for young women and their families to talk with midwives, nurses and their doctors about risks involved during pregnancy. This helps young women address:
  • ways to minimise complications,
  •  have contraception options, and
  • the ability to make informed choices for birthing options.

Benza & Pregnancy

Benza injection helps prevent recurrent ARF. Developing ARF while pregnant poses a very high risk of additional cardiac complications, so it is important to continue taking Benza penicillin injections during pregnancy and while breastfeeding.

References

  1. Sullivan E, Vaughan G, Li Z, et al. The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high-income setting: a prospective cohort study. BJOG: An International Journal of Obstetrics & Gynecology 2019: 127(1):47-56. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.15938
  2. Steer A, Carapetis JR. Prevention and treatment of rheumatic heart disease in the developing world. Nature Review Cardiology, 2009. 6(11):689-98 https://www.nature.com/articles/nrcardio.2009.162 
  3. Manyemba J, Mayosi BM. Penicillin for secondary prevention of rheumatic fever (Review). Cochrane Database of Systematic Reviews 2002; (3). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002227/information