Global Disparities in Outcomes of Pregnant Individuals With Rheumatic Heart Disease: A Scoping Review.
BACKGROUND: Rheumatic heart disease (RHD) remains as 1 of the major contributors to indirect pregnancy-related mortality and morbidity worldwide and disproportionately affects marginalized populations. OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: These findings illustrated using a life-course approach demonstrate opportunities for clinical and public health interventions to improve outcomes in this population.
