Svanvik Teresia, Ramakrishnan Rema, Svensson Martin, Albrektsson Henrik, Basic Carmen, Mandalenakis Zacharias, Rosengren Annika, Schaufelberger Maria, Thunström Erik, Knight Marian
Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
National Perinatal Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK.
Acta Obstet Gynecol Scand. 2024 Dec;103(12):2401-2411. doi: 10.1111/aogs.14972. Epub 2024 Oct 24.
The prevalence of cardiovascular disease during pregnancy (cardiovascular disease diagnosed before, during or up to 6 months after childbirth) and the risk of adverse outcomes associated with it have not been previously described in Sweden. This study examined trends in prevalence of cardiovascular disease and its association with maternal and perinatal outcomes, overall and by timing of diagnosis in relation to pregnancy.
This population-based observational retrospective cohort study consisted of women aged 15-49 years who were registered in the Swedish Medical Birth Register 2000-2019. Prevalence was defined as annual diagnosis of cardiovascular disease per pregnant woman as numerator and all pregnant women per year as denominator. Adverse maternal and perinatal outcomes were analyzed using time-dependent Cox regression and Poisson regression models. Outcomes were obtained during and after childbirth up to 1 year postpartum, depending on the outcome.
There were 2 069 107 births to 1 186 137 women (911 101 primiparous). The prevalence of cardiovascular disease among pregnant women in Sweden during 2000-2019 increased from 0.31% to 1.34%, for non-congenital cardiovascular disease, this was primarily driven by arrythmia (0.11%-0.58%). Primiparous women with cardiovascular disease had a higher risk of eclampsia over-all (aHR 4.50, 95% CI 2.01-10.05) and when diagnosed during pregnancy (aHR 3.22, 95% CI 1.21-8.61); admission to psychiatric ward overall (aHR 2.51, 95% CI 1.30-4.83), and when diagnosed during pregnancy (aHR 2.54, 95% CI 1.21-5.34); and one-year mortality when diagnosed before pregnancy (aHR 1.67, 95% CI 1.16-2.42) and when diagnosed postpartum (aHR 6.59, 95% CI 3.38-12.84), compared to those without cardiovascular disease. Children born to women with cardiovascular disease diagnosed both overall and in relation to timing of diagnosis had an increased risk of being born preterm and small for gestational age.
Cardiovascular disease prevalence among pregnant women in Sweden increased during 2000-2019, primarily driven by arrhythmias. In primiparous women, the timing of diagnosis of cardiovascular disease is important for maternal and perinatal outcomes, including when diagnosed postpartum. This calls for awareness among all staff when planning pregnancy and monitoring women with cardiovascular disease throughout pregnancy and in the postpartum period.
瑞典此前尚未描述过孕期心血管疾病（在分娩前、分娩期间或分娩后6个月内诊断出的心血管疾病）的患病率及其相关不良结局的风险。本研究调查了心血管疾病患病率的趋势及其与孕产妇和围产期结局的关联，总体情况以及根据与妊娠相关的诊断时间进行分析。
这项基于人群的观察性回顾性队列研究纳入了2000年至2019年在瑞典医学出生登记处登记的15至49岁女性。患病率定义为以每年每位孕妇心血管疾病的诊断数为分子，每年所有孕妇数为分母。使用时间依赖性Cox回归和Poisson回归模型分析孕产妇和围产期不良结局。根据结局情况，在分娩期间及产后1年内获取结局数据。
1186137名女性共分娩2069107例（911101例初产妇）。2000年至2019年期间，瑞典孕妇中心血管疾病的患病率从0.31%升至1.34%，非先天性心血管疾病主要由心律失常（从0.11%升至0.58%）驱动。患有心血管疾病的初产妇总体子痫风险更高（调整后风险比4.50，95%置信区间2.01-10.05），妊娠期间诊断出该病时风险更高（调整后风险比3.22，95%置信区间1.21-8.61）；总体入住精神科病房的风险更高（调整后风险比2.51，95%置信区间1.30-4.83），妊娠期间诊断出该病时风险更高（调整后风险比2.54，95%置信区间1.21-5.34）；妊娠前诊断出该病时1年死亡率更高（调整后风险比1.67，95%置信区间1.16-2.42），产后诊断出该病时1年死亡率更高（调整后风险比6.59，95%置信区间3.38-12.84），与未患心血管疾病的女性相比。总体及根据诊断时间来看，患有心血管疾病的女性所生孩子早产和小于胎龄的风险增加。
2000年至2019年期间，瑞典孕妇中心血管疾病患病率上升，主要由心律失常驱动。对于初产妇，心血管疾病的诊断时间对孕产妇和围产期结局很重要，包括产后诊断的情况。这就要求所有工作人员在规划妊娠以及在整个孕期和产后监测患有心血管疾病的女性时提高认识。
