Heart disease complicating pregnancy as a leading cause of maternal deaths in LMIC settings: the Sri Lankan experience

Ayesh Hettiarachchi; Kapila Jayaratne; Chithramalee De Silva; Hemantha Senanayake; Niroshan Lokunarangoda; Suneth Agampodi

doi:10.1016/j.lansea.2023.100223

Heart disease complicating pregnancy as a leading cause of maternal deaths in LMIC settings: the Sri Lankan experience

Lancet Reg Health Southeast Asia. 2023 Jun 6:15:100223. doi: 10.1016/j.lansea.2023.100223. eCollection 2023 Aug.

Authors

Ayesh Hettiarachchi¹, Kapila Jayaratne², Chithramalee De Silva², Hemantha Senanayake³, Niroshan Lokunarangoda⁴, Suneth Agampodi⁵

Affiliations

¹ Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 5008, Sri Lanka.
² Family Health Bureau, Ministry of Health, No: 231, De Saram Place, Colombo 10, Sri Lanka.
³ Faculty of Medicine, University of Colombo, 25, Kynsey Rd, Colombo, 00800, Sri Lanka.
⁴ Department of Medicine & Mental Health, Faculty of Medicine, University of Moratuwa, Bandaranayake Mawatha, Moratuwa, 10400, Sri Lanka.
⁵ International Vaccine Institute, Seoul, South Korea.

Abstract

Background: Heart disease (HD) is one of the leading indirect causes of maternal deaths worldwide, both in high- and low- and middle-income countries (LMICs). This study aims to describe maternal deaths due to cardiovascular disease complicating pregnancy in Sri Lanka.

Methods: The national Maternal Death Surveillance Response (MDSR) system in Sri Lanka investigates all female deaths during pregnancy and 12 months after delivery. These maternal death investigation records were perused in this analysis. Maternal deaths from 2006 to 2018 with HD complicating pregnancy as the immediate or underlying cause of death were re-coded using the ICD-11 classification.

Findings: Of the 2855 pregnancy-related deaths reported to the MDSR from 2006 to 2018, 1646 (57.7%) were confirmed as maternal deaths. Of those, 284 (17.25%) were attributed to HD complicating pregnancy. The cause-specific maternal mortality ratio due to heart disease from 2006 to 2018 was 7.24 per 100,000 live births. Rheumatic heart disease was the leading cause of HD (60, 21.1%), while cardiomyopathies (59, 20.7%) and congenital anomalies (34, 12.0%) accounted for a sizeable share. Medically contraindicated pregnancies accounted for 54 (19%) deaths. Application of the 3-delay model identified 186 (65.5%) cases with possible delays. Out of all deaths, 158 (55.6%) cases were categorized as preventable.

Interpretation: Preventing maternal mortality from HD in LMICs requires a lifecycle approach with situation-specific interventions and highly specialized care. Community awareness, capacity building related to management, and specific infrastructure development will be key strategies.

Funding: None.

Keywords: Ending preventable maternal deaths; Heart Disease; LMIC; Maternal deaths; Pregnancy; SDG; Sri Lanka.