Maternal cardiovascular complications at the time of delivery and subsequent re-hospitalization in the USA, 2010–16

Abstract

Aims Cardiovascular (CV) complications are the leading cause of maternal morbidity and mortality. The objective was to estimate trends in the incidence of peripartum CV complications in the USA between 2010 and 2016. Methods and results This was a retrospective analyses using data from the Healthcare Cost and Utilization Project. We included women with delivery codes consistent with delivery, weighted to a national estimate. The primary outcome was the age-adjusted incidence of CV complications among all deliveries, including complications that occurred during re-hospitalizations. Complications were identified using International Classification of Diseases (ICD) codes. Joinpoint regression was used to evaluate time trends and complications were stratified by type. The secondary outcome was in-hospital maternal death among women with a CV complication. We identified a weighted estimate of 27 408 652 women hospitalized for delivery from 2010 to 2016. Including all years, the complication incidence was 7.36/1000 births [95% confidence interval (CI) 7.18–7.54], with an estimated annual percentage change of 5.8% (95% CI 3.7–7.8%). Cardiac dysrhythmia was the most common complication [3.98/1000 births (95% CI 3.88–4.08)] and acute myocardial infarction was the least common complication [0.11/1000 births (95% CI 0.10–0.11)]. The incidence of hypertension, acute myocardial infarction, and cardiac arrest increased over time, the incidence of congestive heart failure and acute cerebrovascular disease remained stable, the incidence of pulmonary heart disease increased from 2015 onward, and the incidence of cardiac dysrhythmia decreased in 2016. Complications during re-hospitalization accounted for 13.6% (95% CI 13.2–14.1%) of all complications and was highest for acute myocardial infarction [28.1% (95% CI 23.2–33.1)]. Among women with any complication, the mortality rate was 1.20 (95% CI 1.11–1.29) per 100 complications. Conclusion Our analyses suggest the rate of peripartum CV complications are increasing in the USA, which highlights the need for active efforts in research and prevention.

Cardiac medications in obstetric patients

“…The burden of cardiovascular disease during pregnancy continues to rise due to the increasing maternal age at first pregnancy, the rising number of pre-existing cardiovascular risk factors in pregnancy, and a growing number of women of reproductive age with congenital heart disease [1,2]. According to the Registry of Pregnancy and Cardiac Disease, approximately one third of women with cardiovascular disease require medications during pregnancy [3].…”