Key result
Among 11,728 deliveries, the prevalence of cardiac disease was 1.6% (95% CI 1.34-1.80), predominantly driven by rheumatic heart disease (61.5%) and peripartum cardiomyopathy (31.3%).
Why the study?
Cardiac disease is a leading non-obstetric cause of maternal morbidity and mortality, particularly in low- and middle-income countries, but detailed data on prevalence, types, and outcomes in pregnancy are limited.
Cross-Sectional (n=11,728)
No
This study highlights a high burden of late-presenting rheumatic heart disease and peripartum cardiomyopathy among pregnant women in rural South Africa, underscoring the urgent need for earlier detection and integrated cardio-obstetric care.
Indicates substantial cardiac disease burden with high morbidity in South African pregnancies; leaves open optimal screening strategies pending prospective data.
Background: Cardiac disease is a leading non-obstetric cause of maternal morbidity and mortality, particularly in low- and middle-income countries. Methods: Retrospective cross-sectional review of all deliveries from 01 January 2020 to 31 December 2022. Echocardiography-confirmed cardiac disease cases were identified. Data included demographics, lesion type and/or severity (New York Heart Association [NYHA]), timing of diagnosis, delivery characteristics and outcomes. Associations were examined using χ2 and t-tests (p < 0.05). Results: Among 11 728 deliveries, 182 had cardiac disease (prevalence 1.6%, 95% CI: 1.34–1.80). Median age was 26 years (IQR 22–31); 50.6% presented with NYHA III–IV. Rheumatic heart disease (RHD) predominated (61.5%), mainly mitral stenosis (43.8%) and mitral regurgitation (38.3%). Cardiomyopathy accounted for 31.3%; peripartum cardiomyopathy (PPCM) comprised 78.9% of cardiomyopathies, most diagnosed postpartum (64.9%) and frequently with Left Ventricular Ejection Fraction (LVEF) < 45%. Preterm birth occurred in 46.9% of pregnancies, particularly with RHD–MS (mean gestational age (GA) 33.0 ± 6.0 weeks; p = 0.005). Caesarean delivery occurred in 72.0% (131/182), mainly for obstetric (41.8%) rather than cardiac indications. Maternal complications were common (67.6%), including pulmonary oedema (28.6%, 95% CI: 22.1–35.7), pulmonary hypertension (13.2%, 95% CI: 8.6–19.0) and ICU admission (12.1%, 95% CI: 7.8–17.6). Maternal case fatality was 4.9% (9/182; 95% CI: 2.3–9.2). Most neonates had favourable short–term outcomes (5–min Apgar ≥ 7 in 83.5%) and were discharged (87.7%). Conclusion: Rheumatic heart disease and PPCM were the dominant lesions and major drivers of severe morbidity and mortality. Contribution: The high burden of late presentation and severe functional limitation underscores the need for earlier detection, systematised cardio-obstetric care and strengthened primary prevention of RHD.
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Mbili et al. (2026) conducted a cross-sectional in Cardiac disease in pregnancy (n=11,728). Cardiac disease was evaluated on Prevalence of cardiac disease in pregnancy (95% CI 1.34-1.80). Among 11,728 deliveries, the prevalence of cardiac disease was 1.6% (95% CI 1.34-1.80), predominantly driven by rheumatic heart disease (61.5%) and peripartum cardiomyopathy (31.3%).
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