Delivery-Related Maternal Morbidity and Mortality Among Patients With Cardiac Disease.

IF 8.3 2区材料科学 Q1 MATERIALS SCIENCE, MULTIDISCIPLINARY ACS Applied Materials & Interfaces Pub Date : 2024-11-07 DOI:10.1097/AOG.0000000000005780

Isabella Toledo, Heather Czarny, Emily DeFranco, Carri Warshak, Robert Rossi

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Abstract

Objective: To assess the risk of severe maternal morbidity (SMM) and mortality among pregnant patients with cardiovascular disease (CVD).

Methods: 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.

Results: 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%).

Conclusion: 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.

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心脏病患者中与分娩相关的产妇发病率和死亡率。

目的：评估心血管疾病孕妇的严重孕产妇发病率（SMM）和死亡率风险：评估妊娠期心血管疾病（CVD）患者的严重孕产妇发病率（SMM）和死亡率风险：这是一项回顾性队列研究，利用全国住院病人抽样数据库的加权人口估计数据，对2010年至2020年期间的美国分娩住院情况进行研究。主要目的是评估分娩住院时患有心血管疾病的患者中发生 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代码来识别分娩住院、心血管疾病和 SMM 事件。进行了多变量逻辑回归分析，以比较心血管疾病患者和非心血管疾病患者的SMM和死亡风险。鉴于在 SMM、死亡率和心血管疾病负担方面存在巨大的种族和民族差异，次要目标包括评估不同种族和民族群体的 SMM 和死亡率，以及评估每个群体中的人口可归因比例。最后，按基本心血管疾病诊断（如先天性心脏病、慢性心力衰竭）对SMM进行亚组分析。回归模型中使用的变量包括孕产妇的社会经济和人口特征、孕产妇合并症和妊娠特异性并发症：在 38,374,326 名分娩住院患者中，203,448 人（0.5%）患有心血管疾病。与无心血管疾病的患者相比，患有心血管疾病的患者罹患SMM（11.6% vs 0.7%，调整赔率比 [aOR] 12.5，95% CI，12.0-13.1）和孕产妇死亡（每10万次分娩住院中有538例 vs 5例，aOR 44.1，95% CI，35.4-55.0）的风险更高。在心血管疾病类别中，慢性心力衰竭患者的SMM风险最高（aOR为354.4，95% CI为301.0-417.3）。患有心血管疾病的黑人患者的SMM风险（aOR 15.9，95% CI，14.7-17.1）高于无心血管疾病的患者，调整后的人群归因比例为10.5%（95% CI，10.0-11.0%）：结论：妊娠期心血管疾病与SMM风险和死亡率增加有关，慢性心力衰竭患者的SMM风险最高。虽然心血管疾病影响的孕妇不到总人口的1%，但在美国，每10例SMM事件中就有近1例是由心血管疾病引起的。

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来源期刊

ACS Applied Materials & Interfaces 工程技术-材料科学：综合

CiteScore

16.00

自引率

6.30%

发文量

4978

审稿时长

1.8 months

期刊介绍： ACS Applied Materials & Interfaces is a leading interdisciplinary journal that brings together chemists, engineers, physicists, and biologists to explore the development and utilization of newly-discovered materials and interfacial processes for specific applications. Our journal has experienced remarkable growth since its establishment in 2009, both in terms of the number of articles published and the impact of the research showcased. We are proud to foster a truly global community, with the majority of published articles originating from outside the United States, reflecting the rapid growth of applied research worldwide.