Prevalence, trends, and outcomes of cardiovascular diseases in pregnant patients in the USA: 2010–19

Abstract

Background and Aims Contemporary data on the prevalence, trends, and outcomes of cardiovascular, diseases (CVD) in pregnant patients are limited. This study aimed to analyze the, prevalence, trends, and outcomes of CVD and their subtypes in hospitalized pregnant, patients in the United States (U.S.). Methods This retrospective population-based cohort study used the Nationwide Readmission Database to identify all hospitalized pregnant patients from January 1, 2010, to, December 31, 2019. Data analyses were conducted from January-February 2022., Pregnancy-associated hospitalizations were identified. Main outcomes were, prevalence and trend of CVD in pregnant patients. Results 39,212,104 hospitalized pregnant patients were identified: 4,409,924 with CVD (11.3%), and 34,802,180 without CVD (88.8%). The annual age adjusted CVD prevalence, increased from 9.2% in 2010 to 14.8% in 2019 (p < 0.001). Hypertensive disorder of, pregnancy (1069/10,000) was the most common, and aortic dissection (0.1/10,000), was the least common CVD. Trends of all CVD subtypes increased; however, the trend, of valvular heart disease decreased. Age adjusted in-hospital all-cause mortality was, 8.2/10,000 in CVD but its trend decreased from 8.1/10,000 in 2010 to 6.5/10,000 in, 2019 (p < 0.001). CVD was associated with 15.51 times higher odds of in-hospital allcause, mortality compared with non-CVD patients (odds ratio (OR): 15.51, 95% CI, 13.22-18.20, p < 0.001). CVD was associated with higher 6-week postpartum readmission (OR: 1.97, 95% CI: 1.95-1.99), myocardial infarction (OR: 3.04, 95% CI:, 2.57-3.59), and stroke (OR: 2.66, 95% CI: 2.41-2.94) (p < 0.001 for all). Conclusion There is an increasing age adjusted trend in overall CVD and its subtypes among, pregnant patients in the U.S. from 2010 to 2019. Pregnant patients with CVD had, higher odds of in-hospital mortality than those without CVD. However, in-hospital allcause, mortality among patients with and without CVD decreased over the past 10, years. CVD was associated with higher 6-week postpartum all-cause readmission, myocardial infarction, and stroke.

Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review

“…Although the rate of HDP in Australia has remained relatively stable (Box 1), HDP prevalence appears higher in Australia (5.7–8.2% for gestational hypertension and 2.6–9.2% for preeclampsia) compared with Europe (0.9–5.8% and 1.6–5.2% respectively), although similar to North America (1.5–4.0% and 3.0–8.0% respectively) 22 . However, in the US, the rates of overall HDP have increased from 8.9% in 2010 to 14.9% in 2019 5 . In First Nations Australian women, the risk of pregnancy‐related hypertension has been reported as 66% greater than in non‐Indigenous women 23 …”

“…Hypertensive disorders of pregnancy (HDP), including de novo gestational hypertension and preeclampsia, affected 3.4% (about 7500 women) of Australian pregnant women in 2020 2 . Although HDP rates appear relatively stable in Australia, 2 it affects 10.7% of pregnant women in the US, where rates are increasing 5 . In parallel, Australian women today have a high burden of cardiovascular disease (CVD) and risk factors; 31.4% have hypertension, 6 3.8% (age standardised) have known diabetes mellitus, 7 4.8% of women have CVD, 8 the leading cause of death for women in Australia 8 .…”

Cardiovascular risk stratification in young women: the pivotal role of pregnancy

“…Age-adjusted all-cause in-hospital mortality decreased among pregnant patients with CVD (from 8.1/10 000 in 2010 to 6.5/10 000 in 2019, P < 0.001) and without CVD (from 0.22 /10 000 in 2010 to 0.21/10 000 in 2019, P < 0.001). Furthermore, CVD was associated with higher 6-week postpartum all-cause readmission, myocardial infarction, and stroke rates 33 …”

“…Furthermore, CVD was associated with higher 6-week postpartum allcause readmission, myocardial infarction, and stroke rates. 33 The modified WHO (mWHO) classification of maternal cardiovascular risk is a classification schema that is widely used to help in counseling individuals with a preexisting cardiac disease considering or in pregnancy. This risk classification integrates all known maternal cardiovascular risk factors including underlying heart disease and comorbidity; however, preexisting IHD is not included in the current mWHO classification, despite evidence that the number of individuals with IHD who become pregnant is growing.…”

“…This risk classification integrates all known maternal cardiovascular risk factors including underlying heart disease and comorbidity; however, preexisting IHD is not included in the current mWHO classification, despite evidence that the number of individuals with IHD who become pregnant is growing. 33,34 After pregnancy Women who experience APOs during pregnancy have an increased risk of developing CVD later in life. 28,35,36 Women who developed APOs should be monitored closely and receive appropriate interventions to prevent or mitigate the development of CVD; specifically, they need to be more active and to adhere to a healthy lifestyle.…”