From the result of this study, the prevalence of cardiovascular diseases among pregnant mothers attending ANC at JUMC was 16.7%. HDP and CRHD were the predominant findings. Of which HDP accounted for 10.3%, CRHD accounted for 3.2%, atrial septal aneurysm accounted for 1.9% and HHD accounted for 1.3%. Summing up all cardiac conditions together, the prevalence of cardiac disease was 6.4%. The overall prevalence of cardiovascular diseases was higher because of the increased prevalence of hypertensive disorders of pregnancy. In addition, one of the study participants had both HDP and CRHD and, two of the study participants had both HDP and HHD.
HDP was the predominant finding in this study which occurred in 16(10.3%) of the study participants; of which preeclampsia accounted for 6.4% followed by gestational hypertension which accounted for 2.6% of cases. This findings was higher than the previous study done a decade ago in Jimma University specialized Hospital, in which the overall prevalence of HDP were 8.5% from which severe preeclampsia was the predominant finding (51.9%) (13).The same was true in this study also, preeclampsia was the predominant finding which accounted for 62% of cases. The prevalence of preeclampsia in this study was lower than that of the studies done in Dessie referral hospital (8.4%) (14)and Mettu Karl referal hospital (12.4%) (15). The prevalence of HDP in this study was also higher than a study done in St. Paul’s Hospital Millennium medical college in which the prevalence of HDP was 6.5% (2). But, it was lower than a study done among pregnant women attending ante natal care at Gondar town health Institutions, North West Ethiopia 2017, in which the prevalence of hypertensive disorders of pregnancy was 16.8% (16).
CRHD was the second predominant finding in this study, as it is the common finding in developing countries, occurred in 5(3.2%) of the study participants which was nearly similar to the study conducted in 2017 which reported that prevalence of definite RHD in rural Ethiopia to be 3.7% on population based echocardiographic study in Jimma Zone, South West Ethiopia (17). In this study, 5(3.2%) of the study participants had MR (4 moderate and 1 severe), 2(1.3%) of them had MS (1 moderate and 1 severe), 2 (1.3%)of them had TR (1 mild and 1 severe) and 2(1.3%) of them had mild AR. Two patients had moderate pulmonary hypertension. Mitral valve lesions were the commonest findings, from which MR was the predominant finding in contrary to other studies in which MS was the most common rheumatic valvular lesion encountered during pregnancy (11, 18). This finding is similar to other studies done in India and Sudan (9, 19) in which rheumatic heart disease was the predominant cardiac finding in pregnant mothers. But the prevalence of RHD in this study was higher than the study done in St. Paul’s Hospital ,Ethiopia and, Eritrea which showed to be (2.3%) (2, 10). In this study the mean age was 25.8 and the range was 23–30 which is similar to age range of RHD. Since RHD is the disease of poverty, all of the cases with RHD had no enough income. Among them, 60% had no adequate income and 40% had no income at all.
The 3rd predominant finding in this study was atrial septal aneurysm which occurred in 3(1.9%) of the study participants. This finding was lower than that of the study done in Turkey in which the prevalence of atrial septal aneurysm was 5.67% (20) .
The other major finding in this study was HHD which occurred in 2 (1.3%) of the study participants. Both of those study participants had moderate LVH and grade 1 diastolic dysfunction. This could be due to undiagnosed chronic hypertension with superimposed preeclampsia.
When we see the echocardiography findings, most of them had benign findings; 92(59%) of the study participants had mild pericardial effusion. This is thought to be related to hormone mediated volume retention mostly during the 3rd trimester pregnancy. This result was higher than other studies in which the prevalence of pericardial effusion in 3rd trimester pregnancy was 40% (21).Moreover, our study found mild regurgitation 59(37.8%), mostly from the pulmonic valve, which is due to the physiologic change in pregnancy. This finding is similar with Afari HA et al which found valvular regurgitation in tricuspid and pulmonic valves (21).The prevalence of LVH in this study was 3.8% which is less than other study in which the prevalence was 5–10% (21). In this study, 3(1.9%) of the study participants with moderate LVH had hypertensive disorders of pregnancy and 3 (1.9%) of the study participants with mild LVH had normal blood pressure. Blood pressure and LVH had significant correlation at the 0.01 level (2 tailed), Pearson correlation. The ejection fractions of the study participants were within normal range.
Most of the study participants, 132(84.6%), had at least one ECG abnormality. T wave changes occurred in 103(66%) of the study participants. T wave inversion occurred in 83(53.2%) and most of the inversions occurred in V1,75(48.1%) followed by lead III 37(23.5%) and V2 21 (13.5%).T wave flattening occurred in 47(30.1%) and most of the flattening occurred in lead III 33(21.2%) followed by aVF 15 (9.6%) and V1 10(6.4%).Peaked T wave occurred in 3(1.9%) of the study participants mostly fromV1 to V3.In the above description, the summation of T wave inversion with its components as well as T wave flattening is greater than the total T wave changes because one case may have more than one T wave abnormalities. This is similar to the study done in Nepal among 3rd trimester pregnant women which showed: - T wave inversion occurred mostly in V1 (88.3%), V2 (60%), lead III (43.3%) and T wave flattening occurred mostly in lead III (50%), V3 (30%) and aVF (13.3%) (22). This finding is also similar to another study which showed:-T wave inversion occurred mostly in V1 (84%), lead III (54%),V2 (20%) and T wave flattening occurred lead III (26%) and V1 (6%) (23).
Sinus tachycardia occurred in 34(21.8%) of the study participants ;this is because heart rate increases progressively with pregnancy, reaching a peak during the 3rd trimester (22, 24, 25, 26). Nine (5.8%) had left axis deviation which is similar to other studies (22, 23, 24);among them 2 of them had hypertensive disorders of pregnancy and one of them had chronic rheumatic heart disease. One (0.6%) had short PR interval which is common in pregnancy due to physiologic changes and similar findings were seen also in another studies (22,24,25, 26 (22, 24, 25, 26). Six (3.8%) of the study participants had premature ventricular beats which is due to physiologic changes of pregnancy but the result of this study was lower than other studies which showed premature beats to be 59%% (27).This could be due to the single ECG recording we used for our study as this can miss some PVCs. In this study Low voltage of the ECG was seen in 16(10.2%) of the study participants mostly in aVF, aVL, lead III which is similar finding to another study (30) .Nine (5.8%) pregnant mother had counterclockwise rotation of transition zone, 4 (2.6%) had left anterior hemi-block, 1(0.6%) had LVH and 2(1.3%) had sinus bradycardia.
Twenty six (16.7%) of the study participants had Q wave in any lead ;mostly occurred in lead III which accounted for 11.5% followed by aVL which accounted for 3.2% and 1.3% in lead 1. Similar finding was seen in a study done in Nepal in which the increased number of Q waves appeared in 3rd trimester pregnancy highly statistically significant in lead III (35%), II(30%) and aVL (18.3%) and statistically significant in lead I(18.3%) (22). Another study also showed similar findings with significantly increased occurrence of prominent Q waves in lead III (40%), aVF (38%) and II (26%) in 2nd and 3rd trimester of normal pregnancy (23).
Strength and Limitation of the study
This is the 1st prevalence study that included the ECG and echocardiography findings of 3rd trimester pregnant mothers and also findings of atrial septal aneurysm. This is the strength of the study. Therefore, it can be used as a base line study and can give an entry point to other researchers for further wider studies in the area. However, it had its own limitation. First, the study was done in a single center with small sample size. Therefore, it is difficult to generalize to larger population. Second, the study lacked follow-up ECG and Echocardiography investigation to see changes of the abnormalities overtime. That limited us from knowing the outcome of the abnormalities.