title: The burden of antenatal heart disease in South Africa: a systematic review.
abstract: BACKGROUND
  Maternal mortality in South Africa is rising, and heart conditions currently account for 41 per cent of indirect causes of deaths. Little is known about the burden of heart disease in pregnant South Africans.
  
  
  METHODS
  We systematically reviewed the contemporary epidemiology and peripartum outcomes of heart disease in South African women attending antenatal care. Searches were performed in PubMed, ISI Web of Science, the EBSCO Africa-Wide database, the South African Union Catalogue, and the Current and Completed Research database (South Africa). References of included articles were also hand-searched. Studies reporting epidemiologic data on antenatal heart disease in South Africa were included. Data on morbidity and mortality were also collected.
  
  
  RESULTS
  Seven studies were included in the systematic review. The prevalence of heart disease ranged from 123 to 943 per 100,000 deliveries, with a median prevalence of 616 per 100,000. Rheumatic valvular lesions were the commonest abnormalities, although cardiomyopathies were disproportionately high in comparison with other developing countries. Peripartum case-fatality rates were as high as 9.5 per cent in areas with limited access to care. The most frequent complications were pulmonary oedema, thromboembolism, and major bleeding with warfarin use. Perinatal mortality ranged from 8.9 to 23.8 per cent, whilst mitral lesions were associated with low birth weight. Meta-analysis could not be performed due to clinical and statistical heterogeneity of the included studies.
  
  
  CONCLUSIONS
  Approximately 0.6 per cent of pregnant South Africans have pre-existing cardiac abnormalities, with rheumatic lesions being the commonest. Maternal and perinatal morbidity and mortality continue to be very high. We conclude this review by summarising limitations of the current literature and recommending standard reporting criteria for future reports.
authors.affiliation: Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Main Building, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa.
authors.forename: David A
authors.initials: DA
authors.lastname: Watkins
authors.forename: Motshedisi
authors.initials: M
authors.lastname: Sebitloane
authors.forename: Mark E
authors.initials: ME
authors.lastname: Engel
authors.forename: Bongani M
authors.initials: BM
authors.lastname: Mayosi
mesh_terms: D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D006331:Heart Diseases / Q000453:epidemiology*; D006801:Humans; D008427:Maternal Health Services; D008428:Maternal Mortality; D054238:Perinatal Mortality; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology* / Q000401:mortality; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011295:Prenatal Care; D011296:Prenatal Diagnosis; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology