{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T06:07:15Z","timestamp":1783836435321,"version":"3.55.0"},"reference-count":37,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1146525"],"award-info":[{"award-number":["1146525"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001030","name":"National Heart Foundation of Australia","doi-asserted-by":"publisher","award":["108106"],"award-info":[{"award-number":["108106"]}],"id":[{"id":"10.13039\/501100001030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001030","name":"National Heart Foundation of Australia","doi-asserted-by":"publisher","award":["110335"],"award-info":[{"award-number":["110335"]}],"id":[{"id":"10.13039\/501100001030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Rheumatic heart disease (RHD) is the acquired autoimmune heart valve damage resulting from untreated infection with the\n                      <jats:italic>Streptococcus pyogenes<\/jats:italic>\n                      bacterium, which affects people experiencing socioeconomic disadvantage globally. This study measured RHD\u2010associated major adverse cardiovascular events (MACE) and the increased risk associated with pregnancy among women diagnosed with RHD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>Population\u2010level analysis of all births to women with RHD in four Australian jurisdictions was conducted, which covered 71% of the total population and 88% of the Aboriginal and Torres Strait Islander population (a group who experience some of the highest RHD rates reported globally). A retrospective cohort study using linked RHD register and midwives, hospital, and death data collections was designed. Females with at least one birth record aged 12\u201344\u2009years, whose first RHD diagnosis occurred prior to 20\u2009weeks' gestation and age\u2009&lt;\u200935\u2009years, were identified during 2002\u20132017. Survival methods (incorporating mixed effects and time\u2010varying covariates) estimated proportions and hazard ratios. Probability of hospitalization for new RHD\u2010associated MACE was measured for pulmonary hypertension secondary to left heart disease, heart failure, valvular surgery, stroke, infective endocarditis, atrial fibrillation, acute pulmonary edema, cardiomyopathy, and\/or death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 558 pregnancies in women with uncomplicated RHD (345 women) and 88 pregnancies in women with complicated RHD (60 women). During pregnancy, 4.5% of women with uncomplicated RHD and 31.8% of women with complicated RHD experienced new RHD\u2010associated MACE. Risk of RHD\u2010associated MACE was three\u2010 to six\u2010fold higher during periods of pregnancy (compared with non\u2010pregnancy) and did not differ by RHD stage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>After 20\u2009weeks of gestation, women with RHD experienced RHD\u2010associated MACE outcomes at frequencies that were contingent upon RHD stage at 20\u2009weeks of gestation. Awareness of RHD status before 20\u2009weeks of gestation, especially in regions where RHD is endemic, is critical for ensuring women's cardiovascular health in pregnancy and beyond.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70235","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T04:15:31Z","timestamp":1780028131000},"page":"1531-1541","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiovascular outcomes for Australian women with rheumatic heart disease during pregnancy: A retrospective linked data analysis, 2002\u20132017"],"prefix":"10.1111","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3032-6031","authenticated-orcid":false,"given":"Ingrid","family":"Stacey","sequence":"first","affiliation":[{"name":"Cardiovascular Epidemiology Research Centre University of Western Australia  Perth Western Australia Australia"},{"name":"Cardiology Population Health Laboratory Victor Chang Cardiac Research Institute  Darlinghurst New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2027-4231","authenticated-orcid":false,"given":"Mohammed","family":"Junaid","sequence":"additional","affiliation":[{"name":"Dental School and Oral Health Centre of Western Australia University of Western Australia  Nedlands Western Australia Australia"},{"name":"The Kids Research Institute Australia Perth Children\u2019s Hospital  Nedlands Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6347-536X","authenticated-orcid":false,"given":"Holger W.","family":"Unger","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Royal Darwin Hospital  Tiwi Northern Territory Australia"},{"name":"Menzies School of Health Research Charles Darwin University  Casuarina Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0132-9946","authenticated-orcid":false,"given":"Geraldine","family":"Vaughan","sequence":"additional","affiliation":[{"name":"School of Health, Medical and Applied Sciences CQ University  Rockhampton Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5632-2602","authenticated-orcid":false,"given":"Ye\u2019elah","family":"Berman","sequence":"additional","affiliation":[{"name":"Medical School, Division of Obstetrics and Gynaecology University of Western Australia  Perth Western Australia Australia"},{"name":"King Edward Memorial Hospital  Subiaco Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0554-0255","authenticated-orcid":false,"given":"Vicki","family":"Wade","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research Charles Darwin University  Casuarina Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3970-625X","authenticated-orcid":false,"given":"Lee","family":"Nedkoff","sequence":"additional","affiliation":[{"name":"Cardiovascular Epidemiology Research Centre University of Western Australia  Perth Western Australia Australia"},{"name":"Cardiology Population Health Laboratory Victor Chang Cardiac Research Institute  Darlinghurst New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8688-506X","authenticated-orcid":false,"given":"James","family":"Marangou","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research Charles Darwin University  Casuarina Northern Territory Australia"},{"name":"Department of Cardiology Royal Perth Hospital  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5287-5819","authenticated-orcid":false,"given":"Judith M.","family":"Katzenellenbogen","sequence":"additional","affiliation":[{"name":"Cardiovascular Epidemiology Research Centre University of Western Australia  Perth Western Australia Australia"},{"name":"The Kids Research Institute Australia Perth Children\u2019s Hospital  Nedlands Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwac044"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.016851"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjopen\/oeab035"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2022-322146"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S224621"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-023-00940-9"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.009029"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2018-313810"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-311910"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.032561"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2024.101368"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2021.10.017"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15938"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/1753-6405.13259"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/inthealth\/ihy048"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1071\/AH23273"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12744"},{"key":"e_1_2_13_19_1","volume-title":"Rheumatic 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