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

Autor:	Williamson CG; David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.; Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA., Altendahl M; David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA., Martinez G; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA., Ng A; David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.; Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA., Lin JP; David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.; Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, USA., Benharash P; David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.; Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA., Afshar Y; David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.; Molecular Biology Institute, University of California-Los Angeles, Los Angeles, California, USA.
Jazyk:	angličtina
Zdroj:	JACC. Advances [JACC Adv] 2024 Jul 02; Vol. 3 (8), pp. 101071. Date of Electronic Publication: 2024 Jul 02 (Print Publication: 2024).
DOI:	10.1016/j.jacadv.2024.101071
Abstrakt:	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. Competing Interests: Dr Afshar is supported by the 10.13039/100000002National Institute of Health K12 HD000849, the 10.13039/100009633Eunice Kennedy Shriver National Institute of Child Health & Human Development, and the 10.13039/100002575American College of Obstetricians and Gynecologists as part of the Reproductive Scientist Development Program; and is a consultant for Mirvie and has an investigator-initiated project with Natera. Dr Benharash has received consultation fees from Atricure as a proctor. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (© 2024 The Authors.)
Databáze:	MEDLINE
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