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Cardiovascular Severe Maternal Morbidity and Mortality at Delivery
Quick Takes
- The incidence of cardiovascular severe maternal morbidity has increased between 1999 and 2015. Maternal mortality decreased over this time but remains elevated.
- In this study cohort, risk factors for maternal mortality included race/ethnicity, insurance status, postpartum hemorrhage, and systemic lupus erythematosus.
Study Questions:
What is the relationship between cardiovascular severe maternal morbidity (CSMM) and mortality at delivery hospitalizations?
Methods:
This retrospective cohort study used the Health Care Cost and Utilization Project, Nationwide Inpatient Sample to identify delivery hospitalizations with CSMM from 1999 to 2015. Temporal trends in CSMM and associated case-fatality were examined. Characteristics of people with CSMM associated with mortality were analyzed using logistic regression.
Results:
A total of 11,152 cases out of 13,791,605 deliveries were complicated by CSMM, with 495 deaths. The incidence of CSMM increased over 15 years: 7.76 to 8.38 per 10,000 delivery hospitalizations (p < 0.001). The case-fatality rate decreased over this time from 6.55 to 2.50 per 100 CSMM events (p = 0.035). Among those with CSMM, risk factors for mortality included the following: Black race (adjusted odds ratio [aOR], 1.80; 95% confidence interval [CI], 1.39, 2.32), Hispanic ethnicity (aOR, 1.44; 95% CI, 1.09, 1.90), Medicaid insurance (aOR, 1.52; 95% CI, 1.22,1.88), postpartum hemorrhage (aOR, 4.06; 95% CI, 3.05-5.41), and systemic lupus erythematosus (aOR, 2.50; 95% CI, 1.31, 4.78).
Conclusions:
While the incidence of CSMM increased over 15 years, the case-fatality rate decreased but remained elevated. Risk of mortality was increased in Black and Hispanic women, and those with Medicaid insurance, postpartum hemorrhage, or systemic lupus erythematosus.
Perspective:
This study describes the changing nature of the cardio-obstetrics patient population over the past 15 years. In clinical practice, we are also seeing increasing numbers of pregnant individuals with pre-existing cardiovascular disease and/or risk factors. The significant increase in CSMM and the associated risk for mortality demonstrates the importance of cardio-obstetrics programs and team-based care, as well as the necessity for all clinicians to be able to identify early signs of cardiovascular decompensation in pregnant patients.
Clinical Topics: Cardiovascular Care Team, Prevention
Keywords: Cardiovascular Diseases, Ethnic Groups, Inpatients, Lupus Erythematosus, Systemic, Medicaid, Morbidity, Obstetrics, Postpartum Hemorrhage, Pregnancy, Risk Factors, Secondary Prevention, Women
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