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CME Credit Offered
CME Credit Offered
Abstract Award
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Poster Session 2

(558) Cardiovascular disease and hypertensive disorders of pregnancy increase severe maternal morbidity risk

Thursday, January 30, 2025
4:00 PM – 6:00 PM  
Objective: Cardiovascular disease (CVD) and hypertensive disorder of pregnancy (HDP) both confer risk of severe maternal morbidity (SMM). Our objective was to examine rates of SMM by CVD and HDP type during delivery hospitalization and 90 days postpartum compared to births without CVD.

Study Design: Retrospective cohort study of pregnant patients > 18 years of age delivering between 2015 and 2020 in the Premier Database. Patients without CVD were compared to patients with six categories of CVD: congenital, ischemic, aortic, pulmonary hypertension (pHTN), cardiomyopathy, and valvular. Patients with multiple types of CVD were included in the analyses for each category. The exposure of interest was any SMM during delivery hospitalization and < 90 days postpartum. Patients were stratified by HDP type: gestational hypertension (GHTN), preeclampsia (PEC), and preeclampsia with severe features (sPEC). Adjusted predicted SMM rate (%) was calculated during delivery and within 90 days postpartum by CVD type stratified by HDP type, adjusted for age, payor status, race, ethnicity, hospital characteristics, and OB comorbidities.  

Results:

Of 4,606,247 deliveries, 22,366 (0.5%) had CVD. The prevalence of HDP in this population was 11.9%. Patients with PEC had higher adjusted predicted SMM rates, independent of CVD. Those with CVD had significantly higher SMM rates across all HDP types. Patients with cardiomyopathy and pHTN who developed sPEC had the highest rates of SMM (26% and 33%) during delivery hospitalization (Figure 1). Acute respiratory distress syndrome (ARDS) and mechanical ventilation were the most common types of SMM during delivery hospitalization, while heart failure/pulmonary edema were the most common < 90 days postpartum (Figure 2).

Conclusion:

Patients with CVD and PEC have a substantial increase in risk of SMM. The indications for the high rates of mechanical ventilation and etiologies of ARDS during delivery should be explored further. Heart failure is the most common postpartum morbidity and care should be targeted to improve surveillance and prevention postpartum.