{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T12:02:28Z","timestamp":1779969748476,"version":"3.53.1"},"reference-count":34,"publisher":"Radcliffe Medical Media Ltd","license":[{"start":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T00:00:00Z","timestamp":1605225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/legalcode"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur Cardiol"],"abstract":"<jats:p>Background: Cardiac disease is an important life-threatening complication during pregnancy. It is frequently seen in pregnant women living in resource-limited areas and often results in premature death. Aim: The aim of this hospital-based longitudinal study was to identify factors related to adverse maternal and neonatal outcomes in pregnant women with cardiac disease in low-resource settings. Methods: The study enrolled 91 pregnant women with congenital or acquired cardiac disease over a period of 2 years in Kenya. Results: Maternal and early neonatal deaths occurred in 12.2% and 12.6% of cases, respectively. The risk of adverse outcomes was significantly increased in those with pulmonary oedema (OR 11, 95% CI [2.3\u201352]; p=0.002) and arrhythmias (OR 16.9, 95% CI [2.5\u2013113]; p=0.004). Limited access to care was significantly associated with adverse maternal outcomes (p\u22640.001). Conclusion: Many factors contribute to adverse maternal and neonatal outcomes in pregnant women with cardiac disease. Access to comprehensive specialised care may help reduce cardiac-related complications during pregnancy.<\/jats:p>","DOI":"10.15420\/ecr.2020.04","type":"journal-article","created":{"date-parts":[[2020,11,18]],"date-time":"2020-11-18T09:59:02Z","timestamp":1605693542000},"source":"Crossref","is-referenced-by-count":9,"title":["Factors Related to Maternal Adverse Outcomes in Pregnant Women with Cardiac Disease in Low-resource Settings"],"prefix":"10.15420","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8444-1425","authenticated-orcid":false,"given":"Philippe Amubuomombe","family":"Poli","sequence":"first","affiliation":[{"name":"Department of Reproductive Health, Moi University School of Medicine, Eldoret, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elkanah Omenge","family":"Orang\u2019o","sequence":"additional","affiliation":[{"name":"Department of Reproductive Health, Moi University School of Medicine, Eldoret, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Mwangi","sequence":"additional","affiliation":[{"name":"Department of Behavioural Sciences, Moi University School of Medicine, Eldoret, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix Ayub","family":"Barasa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6096","published-online":{"date-parts":[[2020,11,13]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Ashrafi R, Curtis SL. Heart disease and pregnancy. Cardiol Ther 2017;6:157\u201373. https:\/\/doi.org\/10.1007\/s40119-017-0096-4; PMID: 28681178.","DOI":"10.1007\/s40119-017-0096-4"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Ertekin E, Van Hagen IM, Salam AM, et al. Ventricular tachyarrhythmia during pregnancy in women with heart disease: data from the ROPAC, a registry from the European Society of Cardiology. Int J Cardiol 2016;220:131\u20136. https:\/\/doi.org\/10.1016\/j.ijcard.2016.06.061; PMID: 27376569.","DOI":"10.1016\/j.ijcard.2016.06.061"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Diao M, Kane A, Ndiaye MB, et al. Pregnancy in women with heart disease in sub-Saharan Africa. Arch Cardiovasc Dis 2011;104:370\u20134. https:\/\/doi.org\/10.1016\/j.acvd.2011.04.001; PMID: 21798468.","DOI":"10.1016\/j.acvd.2011.04.001"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr 2016;27:89\u201394. https:\/\/doi.org\/10.5830\/CVJA-2016-021; PMID: 27213856. DOI: 10.5830\/cvja-2016-021","DOI":"10.5830\/CVJA-2016-021"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy: the Task Force for the Management of Cardiovascular Diseases During Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2018;39:3165\u2013241. https:\/\/doi.org\/10.1093\/eurheartj\/ehy340; PMID: 30165544.","DOI":"10.1093\/eurheartj\/ehy478"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"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. Eur J Heart Fail 2016;18:523\u201333. https:\/\/doi.org\/10.1002\/ejhf.501; PMID: 27006109. DOI: 10.1002\/ejhf.501","DOI":"10.1002\/ejhf.501"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Silversides CK, Grewal J, Mason J, et al. Pregnancy outcomes in women with heart disease: the CARPREG II study. J Am Coll Cardiol 2018;71:2419\u201330. https:\/\/doi.org\/10.1016\/j.jacc.2018.02.076; PMID: 29793631.","DOI":"10.1016\/j.jacc.2018.02.076"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015;16:233\u201371. https:\/\/doi.org\/10.1093\/ehjci\/jev014; PMID: 25712077. DOI: 10.1093\/ehjci\/jev014","DOI":"10.1093\/ehjci\/jev014"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Elkayam U, Goland S, Pieper PG, Silverside CK. High-risk cardiac disease in pregnancy: part I. J Am Coll Cardiol 2016;68:396\u2013410. https:\/\/doi.org\/10.1016\/j.jacc.2016.05.048; PMID: 27443437. DOI: 10.1016\/j.jacc.2016.05.048","DOI":"10.1016\/j.jacc.2016.05.048"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Adam K. Pregnancy in women with cardiovascular diseases. Methodist Debakey Cardiovasc J 2017;13:209\u201315. https:\/\/doi.org\/10.14797\/mdcj-13-4-209; PMID: 29744013. DOI: 10.14797\/mdcj-10-3-209","DOI":"10.14797\/mdcj-13-4-209"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Meah VL, Cockcroft JR, Backx K, et al. Cardiac output and related haemodynamics during pregnancy: a series of meta-analyses. Heart 2016;102:518\u201326. https:\/\/doi.org\/10.1136\/heartjnl-2015-308476; PMID: 26794234. DOI: 10.1136\/heartjnl-2015-308476","DOI":"10.1136\/heartjnl-2015-308476"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Sanghavi M, Rutherford JD. Cardiovascular physiology of pregnancy. Circulation 2014;130:1003\u20138. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.114.009029; PMID: 25223771. DOI: 10.1161\/circulationaha.114.009029","DOI":"10.1161\/CIRCULATIONAHA.114.009029"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Liu LX, Arany Z. Maternal cardiac metabolism in pregnancy. Cardiovasc Res 2014;101:545\u201353. https:\/\/doi.org\/10.1093\/cvr\/cvu009; PMID: 24448314.","DOI":"10.1093\/cvr\/cvu009"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Moussa HN, Rajapreyar I. Comment on ACOG Practice Bulletin No. 212: pregnancy and heart disease. Obstet Gynecol 2019;134:881\u20132. https:\/\/doi.org\/10.1097\/AOG.0000000000003497; PMID: 31568352. DOI: 10.1097\/aog.0000000000003497","DOI":"10.1097\/AOG.0000000000003497"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Pieper PG. Pre-pregnancy risk assessment and counselling of the cardiac patient. Neth Heart J 2011;19:477\u201381. https:\/\/doi.org\/10.1007\/s12471-011-0188-z; PMID: 21901506. DOI: 10.1007\/s12471-011-0188-z","DOI":"10.1007\/s12471-011-0188-z"},{"key":"ref15","unstructured":"Cardiovascular disorders. In: Cunningham F, Leveno K, Bloom S, et al., eds. Williams Obstetrics. 24th ed. New York: McGraw-Hill, 2014."},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Pieper PG. The pregnant woman with heart disease: management of pregnancy and delivery. Neth Heart J 2012;20:33\u20137. https:\/\/doi.org\/10.1007\/s12471-011-0209-y; PMID: 22068733. DOI: 10.1007\/s12471-011-0209-y","DOI":"10.1007\/s12471-011-0209-y"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"van Hagen IM, Thorne SA, Taha N, et al. Pregnancy outcomes in women with rheumatic mitral valve disease: results from the registry of pregnancy and cardiac disease. Circulation 2018;137:806\u201316.https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.117.032561; PMID: 29459466. DOI: 10.1161\/circulationaha.117.032561","DOI":"10.1161\/CIRCULATIONAHA.117.032561"},{"key":"ref18","unstructured":"RHD Australia, National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Pregnancy in patients with rheumatic heart disease. In: The Australian Guideline for Prevention, Diagnosis and Management of Acute Rheumatic Fever and Rheumatic Heart Disease. 2nd ed. 2012; 98\u2013136. https:\/\/ranzcog.edu.au\/RANZCOG_SITE\/media\/RANZCOG-MEDIA\/Women%27s%20Health\/RHD-guideline.pdf (accessed 7 September 2020)."},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Dogra Y, Suri V, Aggarwal N, Dogra RK. Induction of labor with oxytocin in pregnancy with low-risk heart disease: a randomized controlled trial. Turk J Obstet Gynecol 2019;16:213\u201318. https:\/\/doi.org\/10.4274\/tjod.galenos.2019.59932; PMID: 32231850. DOI: 10.4274\/tjod.galenos.2019.59932","DOI":"10.4274\/tjod.galenos.2019.59932"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"D\u00fcnser MW, Towey RM, Amito J, Mer M. 2017; Intensive care medicine in rural sub-Saharan Africa. Anaesthesia 2017;72:181\u20139. https:\/\/doi.org\/10.1111\/anae.13710; PMID: 27868190. DOI: 10.1111\/anae.13710","DOI":"10.1111\/anae.13710"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Bajwa SK, Bajwa SJ, Kaur J, et al. Is intensive care the only answer for high risk pregnancies in developing nations? J Emerg Trauma Shock 2010;3:331\u20136. https:\/\/doi.org\/10.4103\/0974-2700.70752; PMID: 21063554. DOI: 10.4103\/0974-2700.70752","DOI":"10.4103\/0974-2700.70752"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Lalani HS, Waweru-Siika W, Kussin PS. Reply: critical care in sub-Saharan Africa: is it ready for prime time? Ann Am Thorac Soc 2019;16:157\u20138. https:\/\/doi.org\/10.1513\/AnnalsATS.201809-630LE; PMID: 30321062. DOI: 10.1513\/annalsats.201809-630le","DOI":"10.1513\/AnnalsATS.201809-630LE"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Tun\u00e7alp \u00d6, Souza JP, Hindin MJ, et al. Education and severe maternal outcomes in developing countries: a multicountry cross-sectional survey. BJOG 2014;121(Suppl 1):57\u201365. https:\/\/doi.org\/10.1111\/1471-0528.12634; PMID: 24641536. DOI: 10.1111\/1471-0528.12634","DOI":"10.1111\/1471-0528.12634"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Dingemann C, Sonne M, Ure B, et al. Impact of maternal education on the outcome of newborns requiring surgery for congenital malformations. PLoS One 2019;14:e0214967. https:\/\/doi.org\/10.1371\/journal.pone.0214967; PMID: 30958858. DOI: 10.1371\/journal.pone.0214967","DOI":"10.1371\/journal.pone.0214967"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Ugwuja EI, Akubugwo EI, Ibiam UA, Obidoa O. Maternal sociodemographic parameters: impact on trace element status and pregnancy outcomes in Nigerian women. J Health Popul Nutr 2011;29:156. https:\/\/doi.org\/10.3329\/jhpn.v29i2.7858; PMID: 21608425. DOI: 10.3329\/jhpn.v29i2.7858","DOI":"10.3329\/jhpn.v29i2.7858"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Calvello EJ, Skog AP, Tenner AG, Wallis LA. Applying the lessons of maternal mortality reduction to global emergency health. Bull World Health Organ 2015;93:417\u201323. https:\/\/doi.org\/10.2471\/BLT.14.146571; PMID: 26240463. DOI: 10.2471\/blt.14.146571","DOI":"10.2471\/BLT.14.146571"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Pieper PG, Hoendermis ES. Pregnancy in women with pulmonary hypertension. Neth Heart J 2011;19:504\u20138. https:\/\/doi.org\/10.1007\/s12471-011-0219-9; PMID: 22068738.","DOI":"10.1007\/s12471-011-0219-9"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Balci A, Sollie-Szarynska KM, van der Bijl AGL, et al. Prospective validation and assessment of cardiovascular and offspring risk models for pregnant women with congenital heart disease. Heart 2014;100:1373\u201381. https:\/\/doi.org\/10.1136\/heartjnl-2014-305597; PMID: 25034822. DOI: 10.1136\/heartjnl-2014-305597","DOI":"10.1136\/heartjnl-2014-305597"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Titaley CR, Dibley MJ, Roberts CL. Type of delivery attendant, place of delivery and risk of early neonatal mortality: analyses of the 1994\u20132007 Indonesia Demographic and Health Surveys. Health Policy Plan 2012;27:405\u201316. https:\/\/doi.org\/10.1093\/heapol\/czr053; PMID: 21810892. DOI: 10.1093\/heapol\/czr053","DOI":"10.1093\/heapol\/czr053"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Ruys TP, Roos-Hesselink JW, Pijuan-Dom\u00e8nech A, et al. Is a planned Caesarean section in women with cardiac disease beneficial? Heart 2015;101:530\u20136. https:\/\/doi.org\/10.1136\/heartjnl-2014-306497; PMID: 25539946. DOI: 10.1136\/heartjnl-2014-306497","DOI":"10.1136\/heartjnl-2014-306497"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Dsouza MC, Shivappagoudar VM, Kedlaya A, et al. Anaesthetic management of a patient with severe aortic stenosis for caesarean section: a case report. Int J Res Med Sci 2015;3:2854\u20136. https:\/\/doi.org\/10.18203\/2320-6012.ijrms20150840. DOI: 10.18203\/2320-6012.ijrms20150840","DOI":"10.18203\/2320-6012.ijrms20150840"},{"key":"ref32","unstructured":"Easter SR, Rouse CE, Duarte V, et al. Planned vaginal delivery and cardiovascular morbidity in pregnant women with heart disease. Am J Obstet Gynecol 2020;222:77e1\u201311. https:\/\/doi.org\/10.1016\/j.ajog.2019.07.019; PMID: 31310750."},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"Hrycyk J, Kaemmerer H, Nagdyman N, et al. Mode of delivery and pregnancy outcome in women with congenital heart disease. PLoS One 2016;11:e0167820. https:\/\/doi.org\/10.1371\/journal.pone.0167820; PMID: 28006009. 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