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Disease burden of cardiovascular conditions complicating pregnancy in Sri Lanka: a protocol
Ayesh Hettiarachchi1, Niroshan Lokunarangoda2, Thilini Agampodi1
1Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, 5008, Sri Lanka.
Insights
Cardiovascular diseases (CVD) are a major cause of maternal deaths. This study in Sri Lanka aims to assess CVD burden in pregnancy and develop a risk model to improve maternal health outcomes.
Area of Science:
- Cardiology
- Maternal Health
- Public Health
Background:
- Cardiovascular diseases (CVD) are a leading indirect cause of maternal mortality globally.
- In Sri Lanka, CVD is the second leading cause of maternal death, with current screening limited to clinical assessment.
- A lack of evidence-based guidelines may lead to underestimation of the CVD burden in pregnant populations.
Purpose of the Study:
- To determine the prevalence of cardiovascular disease in early pregnancy in Sri Lanka.
- To develop a risk prediction model for CVD in pregnancy suitable for field clinics.
- To reduce the impact of cardiovascular disease on maternal health in Sri Lanka.
Main Methods:
- A prospective cohort study was conducted in Sri Lanka's Anuradhapura district.
- Pregnant women underwent risk assessment via history and clinical examination, with referrals for echocardiograms as needed.
- Participants were followed throughout pregnancy, with data on antenatal admissions and postpartum morbidities collected.
Main Results:
- This study represents the largest investigation of its kind in the local context.
- Findings will provide crucial data on the burden of CVD in pregnant women in Sri Lanka.
- The developed risk prediction model will aid in early identification and management of CVD.
Conclusions:
- The study will inform the development of national guidelines for managing CVD in pregnancy.
- Implementing the risk prediction model can significantly reduce maternal morbidity and mortality due to CVD.
- This research is vital for improving cardiovascular care in pregnant women in Sri Lanka.
Background:
Cardiovascular diseases (CVD) are the commonest indirect medical cause of maternal deaths worldwide, both in high-income and low and middle-income countries. To minimize the effects of CVD in pregnancy, proper risk assessment and appropriate referral is required. In Sri Lanka, cardiovascular disease complicating pregnancy is a significant cause of maternal mortality, second only to postpartum hemorrhage. Screening for CVD in pregnancy in Sri Lanka is limited to a routine clinical assessment. Evidence-based guidelines are yet to be developed, and this deficit may have resulted in a substantial underestimation of the CVD burden. This study aims to determine the burden of CVD in early pregnancy and develop a risk prediction model to be used in field pregnancy clinics in Sri Lanka to reduce CVD effects in pregnancy.
Methods:
A prospective cohort study was carried out in the Anuradhapura district, Sri Lanka. Following registration to the antenatal care, pregnant women fulfilling the eligibility criteria were invited to attend a special clinic at their relevant Medical Officer of Health (MOH) area. Risk assessment was done through history and a clinical examination, and suspected/probable cases were referred for an echocardiogram by a consultant cardiologist. All the recruited participants in the first trimester were prospectively followed up and screened again between 24-28 weeks of the period of amenorrhoea (POA). Antenatal ward admissions with CVD complicating pregnancy will be extracted, and a telephone interview will be carried out between 6-12 weeks after the expected delivery date to cover postpartum morbidities.
Discussion:
This proposed study will be the largest of its kind carried out in the local setting. The study's findings will be beneficial for policymakers to develop guidelines to reduce maternal cardiovascular disease morbidities and mortalities in Sri Lanka.
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