Better care for pregnant women with RHD: What works?

Rheumatic heart disease (RHD) persists glob-ally as a chronic disease of inequity with added impact inpregnancy. This research aims to identify and examine gapsand facilitators in models of care for women with RHD witha focus on health service

Caring for pregnant women with rheumatic heart disease: A qualitative study of health service provider perspectives

Background: Rheumatic heart disease (RHD) persists in low-middle-income countries and in high-income countries where there are health inequities. RHD in pregnancy (RHD-P) is associated with poorer maternal and perinatal outcomes. Our study examines models of care for women with RHD-P from the perspectives of health care providers. Methods: A descriptive qualitative study exploring Australian health professionals' perspectives of care pathways for women with RHD-P. Thematic analysis of semi-structured interviews with nineteen participants from maternal health and other clinical and non-clinical domains related to RHD-P. Results: A constellation of factors challenged the provision of integrated women-centred care, related to health systems, workforces and culture. Themes that impacted on the provision of quality woman-centred care included conduits of care - helping to break down silos of information, processes and access; 'layers on layers' - reflecting the complexity of care issues; and shared understandings - factors that contributed to improved understandings of disease and informed decision-making. Conclusions: Pregnancy for women with RHD provides an opportunity to strengthen health system responses, improve care pathways and address whole-of-life health. To respond effectively, structural and cultural changes are required including enhanced investment in education and capacity building - particularly in maternal health - to support a better informed and skilled workforce. Aboriginal Mothers and Babies programs provide useful exemplars to guide respectful effective models of care for women with RHD, with relevance for non-Indigenous women in high-risk RHD communities. For key goals to be met in the context of RHD, maternal health must be better integrated into RHD strategies and RHD better addressed in maternal health

Rheumatic heart disease in pregnancy: New strategies for an old disease?

RHD in pregnancy (RHD-P) is associated with an increased burden of maternal and perinatal morbidity and mortality. A sequellae of rheumatic fever resulting in heart valve damage if untreated, RHD is twice as common in women. In providing an historical overview, this commentary provides context for prevention and treatment in the 21 st century. Four underlying themes inform much of the literature on RHD-P: its association with inequities; often-complex care requirements; demands for integrated care models, and a life-course approach. While there have been some gains particularly in awareness, strengthened policies and funding strategies are required to sustain improvements in the RHD landscape and consequently improve outcomes. As the principal heart disease seen in pregnant women in endemic regions, it is unlikely that the Sustainable Development Goal 3 target of reduced global maternal mortality ratio can be met by 2030 if RHD is not better addressed for women and girls

Rheumatic heart disease in pregnancy: How can health services adapt to the needs of Indigenous women? A qualitative study

Objectives: To study rheumatic heart disease health literacy and its impact on pregnancy, and to identify how health services could more effectively meet the needs of pregnant women with rheumatic heart disease. Materials and methods: Researchers observed and interviewed a small number of Aboriginal women and their families during pregnancy, childbirth and postpartum as they interacted with the health system. An Aboriginal Yarning method of relationship building over time, participant observations and interviews with Aboriginal women were used in the study. The settings were urban, island and remote communities across the Northern Territory. Women were followed interstate if they were transferred during pregnancy. The participants were pregnant women and their families. We relied on participants’ abilities to tell their own experiences so that researchers could interpret their understanding and perspective of rheumatic heart disease. Results: Aboriginal women and their families rarely had rheumatic heart disease explained appropriately by health staff and therefore lacked understanding of the severity of their illness and its implications for childbearing. Health directives in written and spoken English with assumed biomedical knowledge were confusing and of limited use when delivered without interpreters or culturally appropriate health supports. Conclusions: Despite previous studies documenting poor communication and culturally inadequate care, health systems did not meet the needs of pregnant Aboriginal women with rheumatic heart disease. Language‐appropriate health education that promotes a shared understanding should be relevant to the gender, life‐stage and social context of women with rheumatic heart disease

Longitudinal analysis of lung function in pregnant women with and without asthma

Abstract not available.Megan E. Jensen, Annelies L. Robijn, Peter G. Gibson, Christopher Oldmeadow, Vicki Clifton, Warwick Giles, Vanessa E. Murphy, Andrew Woods, Kirsten McCaffery, Joerg Mattes, Michael Peek, Andrew Bisits, Leonie Callaway, Helen Barrett, John Attia, Christopher Doran, Sean K.M. Seeho, Paul Colditz, Andrew Searles and Alistair Abbot

Longitudinal analysis of lung function in pregnant women with and without asthma

Background: Spirometry is commonly used to assess and monitor lung function. It may also be a useful tool to monitor maternal health during pregnancy. However, large studies examining lung function across gestation are limited. Also, whether spirometry values follow the same pattern during pregnancy in women with and without asthma is unknown. Objective: To investigate the effect of advancing gestation, and its interaction with asthma, on lung function in a large well-defined cohort of pregnant women. Methods: Data were obtained from prospective cohorts involving women with (n = 770) and without (n = 259) asthma (2004-2017), recruited between 12 and 22 weeks' gestation. Lung function (forced vital capacity [FVC], FEV , FEV :FVC%) was assessed periodically during pregnancy using spirometry. Multilevel mixed-effect regression models were used to assess changes in lung function over gestation. Results: Asthma had a significant effect on baseline lung function (FEV %, −9%; FVC%, −3%; FEV :FVC%, −4%). FVC% decreased with advancing gestation (−0.07%/wk; 95% CI, −0.10 to −0.04]), as did FEV %, but only among those without asthma (women without asthma: −0.14%/wk, 95% CI, −0.22 to −0.06%; compared with women with asthma: 0.02%/wk, 95% CI, −0.01 to 0.06). FEV :FVC% remained relatively stable for women without asthma (0.03%/wk; 95% CI, −0.08 to 0.02), but increased for women with asthma (0.06%/wk; 95% CI, 0.04 to 0.16). Conclusions: Data suggest that advancing gestation negatively affects FVC% and FEV %. This is consistent with extrapulmonary restriction from advancing pregnancy. Yet, the presence of asthma altered the trajectories of FEV % and FEV :FVC%. Optimal asthma management during pregnancy might have opposed the negative effects of gestation on lung function. 1 1 1 1 1 1 1 1