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The following is a summary of “Delivery-Related Maternal Morbidity and Mortality Among Patients With Cardiac Disease,” published in the November 2024 issue of Obstetrics and Gynecology by Toledo et al.
Cardiovascular disease (CVD) in pregnancy increases the risk of severe maternal morbidity (SMM) and mortality, with notable racial disparities in outcomes.
Researchers conducted a retrospective study assessing the risk of SMM and maternal mortality among pregnant patients with CVD.
They analyzed U.S. delivery hospitalization data from the National Inpatient Sample (NIS) database (2010-2020). The SMM and maternal mortality were identified using the International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9/ICD-10-CM) codes. Multivariable logistic regression analyses were performed to notice the risks of SMM and mortality between patients with CVD and those without CVD. The models accounted for socioeconomic, demographic, and clinical characteristics, including pregnancy-specific complications and comorbidities.
The results showed 38,374,326 delivery hospitalizations, 203,448 (0.5%) involved patients with CVD. Patients with CVD had higher risks of SMM (11.6% vs 0.7%, aOR 12.5, 95% CI 12.0-13.1) and maternal death (538 vs. 5 per 100,000 delivery hospitalizations, aOR 44.1, 95% CI 35.4-55.0) compared to those without CVD. Among CVD categories, patients with chronic heart failure had the highest risk of SMM (aOR 354.4, 95% CI 301.0-417.3). Black patients with CVD had a higher risk of SMM (aOR 15.9, 95% CI 14.7-17.1), with an adjusted population attributable fraction of 10.5% (95% CI 10.0-11.0).
They concluded that CVD in pregnancy was associated with an increased risk of SMM and mortality, with the highest risk seen among patients with chronic heart failure.
