Racial Differences in Delivery Outcomes Among Women With Peripartum Cardiomyopathy

Gambahaya, Ellise T.; Minhas, Anum; Sharma, Garima; Vaught, Arthur J.; Adamo, Luigi; Zakaria, Sammy; Michos, Erin D.; Hays, Allison G.

doi:10.1016/j.cjco.2021.12.004

Cited by 9 publications

(5 citation statements)

References 15 publications

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“…During the study time period, the prevalence of arrhythmia increased greatly for both Black and White pregnant individuals from 76.59/100,000 to 188.70/100,000 for Black (a 146% increase) and 55.49/100,000 to 179.19/100,000 for White (a 225% increase). Our results are in line with other NIS studies which have shown that Black pregnant individuals face a disproportionate burden of preeclampsia, peripartum cardiomyopathy, and severe maternal morbidity ( 24 – 26 ).…”

Section: Discussionsupporting

confidence: 92%

Temporal trends of arrhythmias at delivery hospitalizations in the United States: Analysis from the National Inpatient Sample, 2009–2019

Thakkar

Kwapong²,

Patel³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCardiac arrhythmias are associated with increased maternal morbidity. There are limited data on trends of arrhythmias among women hospitalized for delivery.Materials and methodsWe used the National Inpatient Sample (NIS) database to identify delivery hospitalizations for individuals aged 18–49 years between 2009 to 2019 and utilized coding data from the 9th and 10th editions of the International Classification of Diseases to identify supraventricular tachycardias (SVT), atrial fibrillation (AF), atrial flutter, ventricular tachycardia (VT), and ventricular fibrillation (VF). Arrhythmia trends were analyzed by age, race-ethnicity, hospital setting, and hospital geographic regions. Multivariable logistic regression was used to evaluate the association of demographic, clinical, and socioeconomic characteristics with arrhythmias.ResultsAmong 41,576,442 delivery hospitalizations, the most common arrhythmia was SVT (53%), followed by AF (31%) and VT (13%). The prevalence of arrhythmia among delivery hospitalizations increased between 2009 and 2019. Age > 35 years and Black race were associated with a higher arrhythmia burden. Factors associated with an increased risk of arrhythmias included valvular disease (OR: 12.77; 95% C1:1.98–13.61), heart failure (OR:7.13; 95% CI: 6.49–7.83), prior myocardial infarction (OR: 5.41, 95% CI: 4.01–7.30), peripheral vascular disease (OR: 3.19, 95% CI: 2.51–4.06), hypertension (OR: 2.18; 95% CI: 2.07–2.28), and obesity (OR 1.69; 95% CI: 1.63–1.76). Delivery hospitalizations complicated by arrhythmias compared with those with no arrhythmias had a higher proportion of all-cause in-hospital mortality (0.95% vs. 0.01%), cardiogenic shock (0.48% vs. 0.00%), preeclampsia (6.96% vs. 3.58%), and preterm labor (2.95% vs. 2.41%) (all p < 0.0001).ConclusionPregnant individuals with age > 35 years, obesity, hypertension, valvular heart disease, or severe pulmonary disease are more likely to have an arrhythmia history or an arrhythmia during a delivery hospitalization. Delivery hospitalizations with a history of arrhythmia are more likely to be complicated by all-cause in-hospital mortality, cardiovascular, and adverse pregnancy outcomes (APOs). These data highlight the increased risk associated with pregnancies among individuals with arrhythmias.

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Section: Discussionsupporting

confidence: 92%

Temporal trends of arrhythmias at delivery hospitalizations in the United States: Analysis from the National Inpatient Sample, 2009–2019

Thakkar

Kwapong²,

Patel³

et al. 2022

Front. Cardiovasc. Med.

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“…68 In an analysis of the National Inpatient Sample, after adjustment for clinical and socioeconomic factors, Black and American Indian/Alaska Native women had greater odds of developing peripartum cardiomyopathy compared with White women. 69 More data are needed in this area to better inform risk stratification tools and preventive strategies for these women. For select patients with advanced heart failure, heart transplantation remains the gold standard therapy to improve quality of life and survival.…”

Section: Maternal Heart Failure Outcomes In American Indian/alaska Na...mentioning

confidence: 99%

Status of Maternal Cardiovascular Health in American Indian and Alaska Native Individuals: A Scientific Statement From the American Heart Association

Sharma,

Kelliher,

Deen

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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Cardiovascular disease is the leading cause of pregnancy-related death in the United States. American Indian and Alaska Native individuals have some of the highest maternal death and morbidity rates. Data on the causes of cardiovascular disease–related death in American Indian and Alaska Native individuals are limited, and there are several challenges and opportunities to improve maternal cardiovascular health in this population. This scientific statement provides an overview of the current status of cardiovascular health among American Indian and Alaska Native birthing individuals and causes of maternal death and morbidity and describes a stepwise multidisciplinary framework for addressing cardiovascular disease and cerebrovascular disease during the preconception, pregnancy, and postpartum time frame. This scientific statement highlights the American Heart Association’s factors for cardiovascular health assessment known collectively as Life’s Essential 8 as they pertain to American Indian and Alaska Native birthing individuals. It summarizes the impact of substance use, adverse mental health conditions, and lifestyle and cardiovascular disease risk factors, as well as the cascading effects of institutional and structural racism and the historical trauma faced by American Indian and Alaska Native individuals. It recognizes the possible impact of systematic acts of colonization and dominance on their social determinants of health, ultimately translating into worse health care outcomes. It focuses on the underreporting of American Indian and Alaska Native disaggregated data in pregnancy and postpartum outcomes and the importance of engaging key stakeholders, designing culturally appropriate care, building trust among communities and health care professionals, and expanding the American Indian and Alaska Native workforce in biomedical research and health care settings to optimize the cardiovascular health of American Indian and Alaska Native birthing individuals.

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“…An article has shown that pregnant women with COVID-19 who are of non-White ethnicity, older, overweight, and have pre-existing maternal conditions like chronic hypertension and diabetes, as well as pregnancy-related complications, such as gestational diabetes and pre-eclampsia, are at a higher risk for severe COVID-19, admission to an intensive care unit, invasive ventilation, and maternal death [36]. Additionally, women who had pre-existing diabetes mellitus were reported to have almost twice the possibility of contracting COVID-19 [37]. The increased risks for pregnant women with diabetes emphasize the importance of taking necessary precautions to prevent contraction and ensure a safe pregnancy.…”

Section: Underlying Conditionsmentioning

confidence: 99%

Implications of COVID-19 Pandemic on Pregnancy: Current Status and Controversies

Greenberg,

Vishwakarma,

Tirupattur

et al. 2023

COVID

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The COVID-19 pandemic unnerved the global population in 2019 and has continued to evolve ever since. Throughout this time, investigations concerning the health of the groups most susceptible to this virus, including the elderly, those with compromised immunity or chronic diseases, and pregnant women, have taken place. Numerous articles have been formulated on the effects of COVID-19 infection on maternal, fetal, and neonatal health, but there are many controversies that still exist within the current literature. Even three years later, it is not fully understood how a maternal infection or vaccination of COVID-19 can impact pregnancy and the fetus, and these topics require further investigation and conclusive results. The aim of this article is to explain the risks for a mother and the neonate, during and after pregnancy, with the emergence of the COVID-19 pandemic. Additionally, this report presents the current state of the literature on whether vaccination during pregnancy is more beneficial or harmful. Finally, this review examines studies regarding the exacerbation of the effects of COVID-19 on pregnancies in various organ systems, particularly the cardiovascular system, in relevance to pre-existing and emerging conditions and the ethnicity of the mother.

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Racial Differences in Delivery Outcomes Among Women With Peripartum Cardiomyopathy

Cited by 9 publications

References 15 publications

Temporal trends of arrhythmias at delivery hospitalizations in the United States: Analysis from the National Inpatient Sample, 2009–2019

Temporal trends of arrhythmias at delivery hospitalizations in the United States: Analysis from the National Inpatient Sample, 2009–2019

Status of Maternal Cardiovascular Health in American Indian and Alaska Native Individuals: A Scientific Statement From the American Heart Association

Implications of COVID-19 Pandemic on Pregnancy: Current Status and Controversies

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