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CME Credit Offered
CME Credit Offered
Abstract Award
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Poster Session 2

(622) Comorbid anemia is associated with worsened pregnancy outcomes for patients with cardiac disease in pregnancy

Thursday, January 30, 2025
4:00 PM – 6:00 PM  
Objective: Our aim was to assess whether pregnant patients with comorbid anemia in the setting of cardiac disease experience an increased risk of severe maternal morbidity (SMM) and other adverse pregnancy outcomes.

Study Design: This was a retrospective cohort study using the 2016-2021 National Readmissions Database of all patients with cardiac disease who delivered a singleton infant between 24 and 41 weeks. Patients with cardiac disease as identified by diagnosis codes were included and categorized based on modified World Health Organization (mWHO) criteria, which due to coding limitations was dichotomized as mWHO I or II disease (I-II) versus mWHO II/III, III or IV (II/III+) disease. Logistic regression was used to assess the association between anemia and adverse pregnancy outcomes. A subgroup analysis of patients with iron-deficiency anemia was conducted. Models were adjusted for age, ZIP code, median household income, primary payer, hospital size, hospital teaching status, delivery mode, and comorbid conditions.

Results: Cardiac disease was identified in 61,542 patients in our cohort (47,767 (77.6%) with mWHO I-II disease and 13,775 (22.4%) with mWHO II/III+ disease). Of these patients, 16,122 (26.2%) had anemia. Comorbid anemia was associated with higher odds of SMM/mortality in both mWHO I-II (aOR 4.65, 95% CI 4.16, 5.18) and mWHO II/III+ (aOR 2.25, 95% CI 2.05, 2.47) patients. Comorbid anemia was also associated with blood product transfusion, non-transfusion SMM/mortality, preterm birth, and cesarean delivery (Figure). This relationship persisted for the subgroup of patients with iron-deficiency anemia, with an increased odds of SMM in the setting of anemia seen for patients with both mWHO I-II (aOR 3.68, 95% CI 2.95, 4.58) and mWHO II/III+ (aOR 2.14, 95% CI 1.77, 2.58) (Table).

Conclusion: Comorbid anemia, including iron-deficiency anemia, adversely impacts pregnancy outcomes in pregnant patients with cardiovascular disease. Identifying and treating this modifiable risk factor offers an opportunity to reduce morbidity in this high-risk population.