PREGNANT patients with cardiovascular disease (CVD) face a significantly increased risk of severe maternal morbidity (SMM) and mortality, according to a large US-based study analysing delivery hospitalisations from 2010 to 2020. CVD, which affects less than 1% of pregnant people, nevertheless accounts for a substantial proportion of SMM events, highlighting the critical need for specialised care in this group.
The retrospective cohort study used data from the National Inpatient Sample, examining nearly 38.4 million delivery hospitalisations. Of these, 203,448 patients (0.5%) had CVD. The analysis focused on the risks of SMM and maternal mortality among those with CVD compared to those without, using multivariable logistic regression models to account for socioeconomic, demographic, and clinical variables. Researchers further analysed outcomes by racial and ethnic group, as well as by specific types of cardiovascular disease.
Results showed that pregnant patients with CVD had a notably higher rate of SMM (11.6%) compared to those without CVD (0.7%), with an adjusted odds ratio (aOR) of 12.5 (95% CI, 12.0–13.1). Maternal mortality was also starkly higher among patients with CVD, with a rate of 538 per 100,000 compared to 5 per 100,000 for those without (aOR 44.1; 95% CI, 35.4–55.0). Chronic heart failure posed the highest risk, with an aOR of 354.4 (95% CI, 301.0–417.3). Additionally, Black patients with CVD had an even greater risk of SMM than other racial and ethnic groups, with an aOR of 15.9 (95% CI, 14.7–17.1) and a population attributable fraction of 10.5%.
Overall, this research highlights that while CVD complicates a relatively small number of pregnancies, its impact on maternal health is disproportionately large, contributing to nearly 10% of all SMM events. The findings point to an urgent need for targeted interventions, particularly for high-risk groups such as patients with chronic heart failure and Black patients.
Reference
Kern-Goldberger AR et al. Racial Disparities in Maternal Critical Care: Are There Racial Differences in Level of Care? Obstet Gynecol. 2024;DOI:10.1097/AOG.0000000000005780.
