Role of n-terminal pro-b-type natriuretic peptide as a predictor of cardiovascular complications in pregnant women with rheumatic heart disease

Background and objective: Rheumatic heart disease (RHD) is a common valvular heart disease in our country. RHD in pregnant women is very important as it can lead to many complications during pregnancy and labour. Early diagnosis of complications and appropriate management is essential in reducing maternal mortality. Hence, we intended to find out whether NT-pro BNP at early weeks of gestation will help in predicting the complications during antenatal and postnatal period in pregnant women with RHD. Methods: A prospective study was conducted in a tertiary care hospital in Madurai between January 2021 to December 2022. A total of 30 cases (ANC with RHD) and 30 controls (ANC without RHD) of comparable age were chosen and NT-pro BNP was tested around 20 weeks of gestation. All the cases were followed up throughout their pregnancy and 12 weeks postpartum to identify complications if any. Appropriate management (medical/advanced treatment) was given as required. At the end of the study the NT-pro BNP values of cases and controls were analysed. Results: The value of NT-pro BNP among the ANC with RHD was significantly higher than the ANC without RHD, 53.33% of ANCs were diagnosed as RHD in their antenatal visit only. NT-pro BNP levels compared between advanced treatment and non-advanced treatment group did not show any significant difference. Among the moderate to severe cases of RHD, 16% went for advanced treatment. Interpretation and Conclusions: Rheumatic heart disease is sub-clinical in the population and manifests only during pregnancy and labour. Hence, screening all the ANCs for RHD with ECHO and NT-pro BNP will help in risk stratification of patients and choosing appropriate treatment to reduce the maternal mortality rate.