Toledo Isabella, Czarny Heather, DeFranco Emily, Warshak Carri, Rossi Robert
Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio; and the Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, Kentucky.
Obstet Gynecol. 2025 Jan 1;145(1):e1-e10. doi: 10.1097/AOG.0000000000005780. Epub 2024 Nov 7.
To assess the risk of severe maternal morbidity (SMM) and mortality among pregnant patients with cardiovascular disease (CVD).
This was a retrospective cohort study of U.S. delivery hospitalizations from 2010 to 2020 using weighted population estimates from the National Inpatient Sample database. The primary objective was to evaluate the risk of SMM and maternal mortality among patients with CVD at delivery hospitalization. International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes were used to identify delivery hospitalizations, CVD, and SMM events. Multivariable logistic regression analyses were performed to compare SMM and mortality risk among patients with CVD and those without CVD. Given the substantial racial and ethnic disparities in SMM, mortality, and CVD burden, secondary objectives included evaluating SMM and mortality across racial and ethnic groups and assessing the population attributable fraction within each group. Lastly, subgroup analyses of SMM by underlying CVD diagnoses (eg, congenital heart disease, chronic heart failure) were performed. Variables used in the regression models included socioeconomic and demographic maternal characteristics, maternal comorbidities, and pregnancy-specific complications.
Among 38,374,326 individuals with delivery hospitalizations, 203,448 (0.5%) had CVD. Patients with CVD had an increased risk of SMM (11.6 vs 0.7%, adjusted odds ratio [aOR] 12.5, 95% CI, 12.0-13.1) and maternal death (538 vs 5 per 100,000 delivery hospitalizations, aOR 44.1, 95% CI, 35.4-55.0) compared with those without CVD. Patients with chronic heart failure had the highest SMM risk (aOR 354.4, 95% CI, 301.0-417.3) among CVD categories. Black patients with CVD had a higher risk of SMM (aOR 15.9, 95% CI, 14.7-17.1) than those without CVD with an adjusted population attributable fraction of 10.5% (95% CI, 10.0-11.0%).
CVD in pregnancy is associated with increased risk of SMM and mortality, with the highest risk of SMM among patients with chronic heart failure. Although CVD affects less than 1% of the pregnant population, it contributes to nearly 1 in 10 SMM events in the United States.
评估患有心血管疾病（CVD）的孕妇发生严重孕产妇发病（SMM）和死亡的风险。
这是一项对2010年至2020年美国分娩住院病例的回顾性队列研究，使用了来自国家住院样本数据库的加权人口估计数。主要目的是评估分娩住院时患有CVD的患者发生SMM和孕产妇死亡的风险。采用国际疾病分类第九版和第十版临床修订本编码来识别分娩住院、CVD和SMM事件。进行多变量逻辑回归分析，以比较患有CVD和未患有CVD的患者发生SMM和死亡的风险。鉴于SMM、死亡率和CVD负担方面存在显著的种族和民族差异，次要目标包括评估不同种族和民族群体中的SMM和死亡率，并评估每组中的人群归因分数。最后，对根据潜在CVD诊断（如先天性心脏病、慢性心力衰竭）划分的SMM亚组进行分析。回归模型中使用的变量包括社会经济和人口统计学孕产妇特征、孕产妇合并症以及特定于妊娠的并发症。
在38374326例有分娩住院记录的个体中，203448例（0.5%）患有CVD。与未患有CVD的患者相比，患有CVD的患者发生SMM的风险增加（11.6%对0.7%，调整后的优势比[aOR]为12.5，95%置信区间[CI]为12.0 - 13.1），孕产妇死亡风险增加（每10万例分娩住院中有538例对5例，aOR为44.1，95% CI为35.4 - 55.0）。在CVD类别中，患有慢性心力衰竭的患者发生SMM的风险最高（aOR为354.4，95% CI为301.0 - 417.3）。患有CVD的黑人患者发生SMM的风险（aOR为15.9，95% CI为14.7 - 17.1）高于未患有CVD的黑人患者，调整后的人群归因分数为10.5%（95% CI为10.0 - 11.0%）。
妊娠合并CVD与SMM和死亡风险增加相关，其中慢性心力衰竭患者发生SMM的风险最高。尽管CVD影响不到1%的孕妇群体，但在美国近十分之一的SMM事件中都有它的影响。
