Skip to main content

Rheumatic Heart Disease Australia

RHD Australia

Women, girls, and RHD in pregnancy - Information for health professionals Fact Checked

Written by 

Sara Noonan

Women at risk of RHD during pregnancy

Up to 78% of women with rheumatic heart disease (RHD) in Australia are Aboriginal and/or Torres Strait Islander women.1 Māori and other Pacific Islander women, and potentially women who have migrated from resource-poor countries are also at a high risk of RHD.2 Risk factors for RHD include poverty and poor-quality housing, overcrowded living conditions, and reduced access to medical care. 

Impact of RHD during pregnancy

During pregnancy, the work of the heart is increased by up to 50%.3 For women who have RHD there are several considerations:

  1. Added stress on the heart from pregnancy can result in the development of RHD symptoms, where previously there were no symptoms, or the existence of RHD was unknown. This may result in unexpected complications for mother and baby.4

If a pregnant woman develops heart failure symptoms, experiences unexplained shortness of breath, or needs to sleep with two pillows to assist breathing, the possibility of RHD should be considered and investigated. The earlier RHD is diagnosed and managed, the less likelihood of complications during pregnancy.

  1. Added stress on the heart from pregnancy can result in the worsening of existing RHD symptoms.

Women living with RHD need to be monitored carefully before and during pregnancy by a multi-disciplinary team which includes obstetric and cardiology specialists.

  1. Added stress on the heart can place extra pressure on repaired or mechanical heart valves.

Timing of heart valve surgery and future pregnancies should be part of a comprehensive early management plan for all girls and young women with RHD.

  1. Anticoagulation therapy poses a risk to mother and baby, and needs to be carefully monitored and regulated throughout pregnancy and delivery.

Anticoagulation is required for all girls and women with mechanical prosthetic valves, and may be prescribed if there is atrial fibrillation. Options for anticoagulation during pregnancy requires careful balancing of risk following individual assessment.5

Transitional care

First episodes of ARF are most common among children aged 5 to 14 years, and diagnosis of RHD occurs from the age of 5, and into the 45-50-year age group.6 Therefore, child to adult transitional care that addresses the standards for quality healthcare in adolescents.7 is critical for the continued care of young women who desire future pregnancies. Planning for adulthood should include reproductive health and preconception care, as well as the transition to adult cardiovascular care.

Preconception counselling is important for all young women who have had acute rheumatic fever (ARF) and RHD. It provides an opportunity for young women and their families to talk with midwives and other health professionals about risks during pregnancy, how to minimise complications, contraception options, and being able to make informed choices for birthing options. Obstetric and related planning and care for young Aboriginal and Torres Strait Islander women should be provided within a cultural safety framework and include members of the Aboriginal and Torres Strait Islander health workforce.

Antibiotic prophylaxis during pregnancy

Secondary prophylaxis in the form of regular penicillin injections helps prevent recurrent ARF.8,9 Penicillins do cross the placenta in low concentrations, however, there is no evidence that penicillins have any teratogenic effects on the fetus.10 Developing ARF while pregnant poses a very high risk of additional cardiac complications; therefore, women who have had ARF, and women who have RHD should continue penicillin injections during pregnancy and while breastfeeding, as indicated.11

Resources

Free, accredited e-learning is available on a range of topics related to ARF and RHD, including Women and Girls with RHD, which is endorsed by the Australian College of Midwives.

The RHDAustralia website contains a range of resources and clinical support materials to support midwives, women with RHD, and their families.

A series of short films Sharing a Heartbeat which were directed by Indigenous women, address issues around fertility, pregnancy, and family for young Indigenous women who have RHD. They are available in English, Burarra and Kriol.

This film was developed, written and directed by young Indigenous women, and contains culturally appropriate health information for girls and young women and their families.   Tess has rheumatic heart disease, and she is not sure about her future as a mother.

Articles

Advocate Mum brings life experiences to help develop film

Women’s Health Literacy and Rheumatic Heart Disease

Sharing a Heartbeat - Love, pregnancy, and living with rheumatic heart disease

  • 1. Sullivan E, Vaughan G, Li Z, et al. The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high-income setting: a prospective cohort study. BJOG: An International Journal of Obstetrics & Gynaecology 2019: 127(1):47-56. View Source
  • 2. RHDAustralia (ARF/RHD writing group). The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition); 2020. View Source
  • 3. Hall ME, George EM, Granger JP. El corazón durante el embarazo [The heart during pregnancy]. Revista Española de Cardiología. 2011;64(11):1045-1050. View Source
  • 4. Sullivan E, Vaughan G, Li Z, et al. The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high-income setting: a prospective cohort study. BJOG: An International Journal of Obstetrics & Gynaecology 2019: 127(1):47-56. View Source
  • 5. RHDAustralia (ARF/RHD writing group). The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition); 2020. View Source
  • 6. Katzenellenbogen JM, Bond-Smith D, Seth RJ, et al. The End Rheumatic Heart Disease in Australia Study of Epidemiology (ERASE) Project: data sources, case ascertainment and cohort profile. Clinical Epidemiology. 2019;11:997-1010. View Source
  • 7. World Health Organization & Joint United Nations Programme on HIV/AIDS. Global standards for quality health-care services for adolescents: a guide to implement a standards-driven approach to improve the quality of health care services for adolescents. Volume 2: Implementation guide. Geneva, 2015. View Source
  • 8. Steer A, Carapetis JR. Prevention and treatment of rheumatic heart disease in the developing world. Nature Review Cardiology, 2009. 6(11):689-98 View Source
  • 9. Manyemba J, Mayosi BM. Penicillin for secondary prevention of rheumatic fever (Review). Cochrane Database of Systematic Reviews 2002; (3). View Source
  • 10. Department of Health Therapeutic Goods Administration. Medicines and TGA classifications. 2019. View Source
  • 11. RHDAustralia (ARF/RHD writing group). The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition); 2020. View Source
Last Updated 
22 October 2020
Fact checked? 
Fact checked