(697) Cardiac and obstetric outcomes among individuals with Hereditary Thoracic Aortic Diseases: Leveraging Large EMR Data

Objective: Pregnancy, delivery, and the postpartum time period are times of increased risk for aortic dissection (AD) among patients with hereditary thoracic aortic diseases (HTAD). Due to the relative rarity of AD and HTAD, data on the risks of AD and other cardiac complications comes from small case series. We aimed to leverage Epic Cosmos, a large dataset comprised of electronic medical records from across the country to estimate current risks of AD and cardiac complications among patients with HTAD during pregnancy.

Study Design: We performed a descriptive analysis of a cohort of pregnancies from The Epic Cosmos dataset, which combines data from over 1500 hospitals and >250 million patients. Epic Cosmos was queried for patients with simultaneous diagnoses codes for HTAD (Marfan Syndrome, Loeys-Dietz Syndrome, Vascular Ehlers-Danlos Syndrome and bicuspid associated aortopathy) and pregnancy between July 5, 2021 and July 4, 2024. Rates of AD, other cardiac complications (including aortic rupture, cardiac arrest, cardiac arrhythmia), and pregnancy outcomes were abstracted for all included individuals.

Results: We identified 1171 individuals with HTAD and pregnancy in the selected time frame. Most individuals identified as White (81.6%). Marfan syndrome was the most common HTAD diagnosis (74.6%). The rate of AD in this cohort was 1.1% (n=13). The most common cardiac complication experienced by these individuals was arrhythmia (18.4%). For 698 individuals, complete pregnancy and obstetric outcome data was available, and 46.8% were nulliparous. Approximately 20.8% of patients had a cesarean delivery and 30.5% had a preterm delivery (< 37 weeks). Twelve percent of individuals opted for a form a long-acting reversible contraception following pregnancy (Implant n=27, IUD n=113).

Conclusion:

In this large, contemporary cohort rates of AD were 1.1% among patients with HTAD in pregnancy.  Prospective studies are needed to assess the optimal management of pregnancy among patients with HTAD to decrease cardiac and obstetric complications.