Cardiovascular Disease in Pregnancy: Clinical Outcomes and Cost-Associated Burdens From a National Cohort at Delivery

Catherine G Williamson; Marie Altendahl; Guadalupe Martinez; Ayesha Ng; Jeannette P Lin; Peyman Benharash; Yalda Afshar

doi:10.1016/j.jacadv.2024.101071

Cardiovascular Disease in Pregnancy: Clinical Outcomes and Cost-Associated Burdens From a National Cohort at Delivery

JACC Adv. 2024 Jul 2;3(8):101071. doi: 10.1016/j.jacadv.2024.101071. eCollection 2024 Aug.

Authors

Catherine G Williamson^{1

2}, Marie Altendahl^{1

3}, Guadalupe Martinez³, Ayesha Ng^{1

2}, Jeannette P Lin^{1

4}, Peyman Benharash^{1

2}, Yalda Afshar^{1

3

5}

Affiliations

¹ David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
² Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
³ Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
⁴ Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, USA.
⁵ Molecular Biology Institute, University of California-Los Angeles, Los Angeles, California, USA.

Abstract

Background: Cardiovascular disease (CVD) in pregnancy is a leading cause of maternal morbidity and mortality in the United States, with an increasing prevalence.

Objectives: This study aimed to examine risk factors for adverse maternal cardiac, maternal obstetric, and neonatal outcomes as well as costs for pregnant people with CVD at delivery.

Methods: Using the National Inpatient Sample 2010-2019 and the Internal Classification of Diseases diagnosis codes, all pregnant people admitted for their delivery hospitalization were included. CVD diagnoses included congenital heart disease, cardiomyopathy, ischemic heart disease, arrhythmias, and valvular disease. Multivariable regressions were used to analyze major adverse cardiovascular events (MACE), maternal and fetal complications, length of stay, and resource utilization.

Results: Of the 33,639,831 birth hospitalizations included, 132,532 (0.39%) had CVD. These patients experienced more frequent MACE (8.5% vs 0.4%, P < 0.001), obstetric (24.1% vs 16.6%, P < 0.001), and neonatal complications (16.1% vs 9.5%, P < 0.001), and maternal mortality (0.16% vs 0.01%, P < 0.001). Factors associated with MACE included cardiomyopathy (adjusted OR [aOR]: 49.9, 95% CI: 45.2-55.1), congenital heart disease (aOR: 13.8, 95% CI: 12.0-15.9), Black race (aOR: 1.04, 95% CI: 1.00-1.08), low income (aOR: 1.06, 95% CI: 1.02-1.11), and governmental insurance (aOR: 1.03, 95% CI: 1.00-1.07). On adjusted analysis, CVD was associated with higher odds of maternal mortality (aOR: 9.28, 95% CI: 6.35-13.56), stillbirth (aOR: 1.66, 95% CI: 1.49-1.85), preterm birth (aOR: 1.33, 1.27-1.39), and congenital anomalies (aOR: 1.84, 95% CI: 1.69-1.99). CVD was also associated with an increase of $2,598 (95% CI: $2,419-2,777) per patient during admission for delivery.

Conclusions: CVD in pregnancy is associated with higher rates of adverse outcomes. Our study highlights the association of key clinical and demographic factors with CVD during pregnancy to emphasize those at highest risk for complications.

Keywords: cardio-obstetrics; cardiovascular disease; obstetrics; pregnancy.