Yang Jenny M, Tchakerian Natalie, Silversides Candice K, Siu Samuel C, Spitzer Rachel F, Kosgei Wycliffe, Okun Nanette, Lumsden Rebecca, D'Souza Rohan, Keepanasseril Anish
Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.
Department of Obstetrics and Gynaecology, Liverpool Hospital, Sydney, New South Wales, Australia.
JACC Adv. 2024 Oct 30;3(12):101368. doi: 10.1016/j.jacadv.2024.101368. eCollection 2024 Dec.
Rheumatic heart disease (RHD) remains as 1 of the major contributors to indirect pregnancy-related mortality and morbidity worldwide and disproportionately affects marginalized populations.
In this scoping review, the authors sought to explore the socioeconomic, cultural, and health care access-related causes of global disparities in outcomes of pregnancy among individuals with RHD.
We performed a literature search of all studies published between January 1, 1990, and January 1, 2022, that investigated causes for disparate outcomes in pregnant individuals with RHD.
Of the 3,544 articles identified, 16 were included in the final analysis. The key reasons for disparate outcomes included lack of secondary antibiotic RHD prophylaxis; late and more severe RHD diagnosis, differences in management and antenatal care access; lack of expert and coordinated multidisciplinary care; suboptimal patient health education; inadequate access to RHD medication, intervention and surgery in pregnancy; and limited financial and economic resources.
These findings illustrated using a life-course approach demonstrate opportunities for clinical and public health interventions to improve outcomes in this population.
风湿性心脏病（RHD）仍然是全球间接妊娠相关死亡率和发病率的主要原因之一，对边缘化人群的影响尤为严重。
在本范围综述中，作者试图探讨风湿性心脏病患者妊娠结局全球差异的社会经济、文化和医疗保健可及性相关原因。
我们对1990年1月1日至2022年1月1日期间发表的所有研究进行了文献检索，这些研究调查了风湿性心脏病孕妇结局差异的原因。
在识别出的3544篇文章中，16篇被纳入最终分析。结局差异的关键原因包括缺乏二级抗生素预防风湿性心脏病；风湿性心脏病诊断较晚且病情更严重，管理和产前保健可及性存在差异；缺乏专家和协调的多学科护理；患者健康教育不足；孕期获得风湿性心脏病药物、干预和手术的机会不足；以及有限的财政和经济资源。
这些采用生命历程方法的研究结果表明，临床和公共卫生干预有机会改善该人群的结局。
