Key result
Cardiac disease drives up to ~25% of maternal deaths in low- and middle-income countries.
Why the study?
To assess the frequency of maternal death due to cardiac disease in low- and middle-income countries.
What is the frequency of maternal mortality due to cardiac disease in low- and middle-income countries?
Systematic Review (n=38,486)
Yes
What is the frequency of maternal mortality due to cardiac disease in low- and middle-income countries?
Demonstrates an 'obstetric transition' in LMICs, where pre-existing conditions like cardiac disease become a relatively larger cause of maternal mortality as overall obstetric mortality decreases.
Cardiac disease warrants prioritized screening and management in LMIC antenatal care as overall maternal mortality falls; extends the obstetric transition model for targeted research and policy.
OBJECTIVES: To assess the frequency of maternal death (MD) due to cardiac disease in low- and middle-income countries (LMIC). METHODS: Systematic review searching Medline, EMBASE, Web of Science, Cochrane Library, Emcare, LILACS, African Index Medicus, IMEMR, IndMED, WPRIM, IMSEAR up to 01/Nov/2017. Maternal mortality reports from LMIC reviewing all MD in a given geographical area were included. Hospital-based reports or those solely based on verbal autopsies were excluded. Numbers of MD and cardiac-related deaths were extracted. We calculated cardiac disease MMR (cMMR, cardiac-related MD/100 000 live births) and proportion of cardiac-related MDs among all MDs. Frequency of cardiac MD was compared with the MMR of the country. RESULTS: Forty-seven reports were included, which reported on 38,486 maternal deaths in LMIC. Reported cMMR ranged from 0/100 000 live births (Moldova, Ghana) to 31.9/100 000 (Zimbabwe). The proportion of cardiac-related MD ranged from 0% (Moldova, Ghana) to 24.8% (Sri Lanka). In countries with a higher MMR, cMMR was also higher. However, the proportion of cardiac-related MD was higher in countries with a lower MMR. CONCLUSIONS: The burden of cardiac-related mortality is difficult to assess due limited availability of mortality reports. The proportion of cardiac deaths among all MD appeared to be higher in countries with a lower MMR. This is in line with what has been called 'obstetric transition': pre-existing medical diseases including cardiac disease are becoming relatively more important where the MMR falls.
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Heemelaar et al. (2020) conducted a systematic review in Maternal death due to cardiac disease (n=38,486). Cardiac disease was evaluated on Frequency of maternal death due to cardiac disease (cardiac-related maternal mortality ratio [cMMR] and proportion of cardiac-related maternal deaths). Cardiac disease accounted for up to 24.8% of maternal deaths in low- and middle-income countries, with the proportion of cardiac-related deaths being higher in countries with lower overall maternal mortality.
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