The prevalence of preexisting cardiometabolic comorbidities and cardiovascular disease among pregnant women, as well as pregnancy-related cardiovascular complication rates within one year postpartum, are high and have risen over the past two decades, according to a large-scale pregnancy cohort study published Oct. 6 in Circulation.

Emily S. Lau, MD, FACC, et al., derived a pregnancy cohort from a primary care electronic health record (EHR) database spanning New England hospitals. The Predictive Analysis With Deep Learning Models for Maternal Endpoints cohort comprised 56,833 pregnancies among 38,996 women aged 18-60 years (mean age, 32 years at beginning of pregnancy) between 2001 and 2019. Researchers extracted EHR data by applying machine learning approaches, including natural language processing and large language models, to assess maternal and pregnancy-related cardiovascular outcomes.

Results showed that preexisting cardiovascular disease was present in 4% of pregnancies (age-adjusted 8%). Age-adjusted prevalence increased from 1% in 2001 to 7% in 2019 (p<0.001). Cardiovascular disease was most common in women >40 years vs. younger women, and more frequent in Black and White women vs. those from other racial or ethnic groups.

Findings also revealed that pregnancy-related cardiovascular complications (defined as a composite of maternal death, major adverse cardiovascular events and hypertensive disorders of pregnancy) occurred in 15% (age-adjusted 17%). Age-adjusted complication rates increased from 11% in 2001 to 13% in 2019 (p<0.001).

Notably, cardiovascular complications within one year postpartum were more likely to occur among women with a greater burden of cardiovascular comorbidities and cardiovascular disease (with vs. without cardiovascular complication: obesity 20% vs. 11%, diabetes 6% vs. 3%, hypertension 23% vs. 5%, cardiovascular disease 10% vs. 3%; p<0.001 for all) and among non-Hispanic Black women.

Lau and colleagues write that the overall results highlight "pregnancy from preconception to the post-partum period as a crucial window of opportunity to implement primary prevention strategies and optimize cardiovascular health."

In an accompanying editorial comment, Sadiya S. Khan, MD, MSc, FACC, and Stephanie A. Fisher, MD, MPH, note that "integrating prenatal care with [cardiovascular disease] preventive care has the potential to bend the curve in maternal mortality. However, it will require operationalizing equitable screening, awareness, and treatment of [cardiovascular disease] risk factors during pregnancy, as well as before and after pregnancy, to improve maternal and offspring health for all."

"Our findings confirm what we're seeing at the bedside: more women are entering pregnancy with obesity, hypertension and diabetes – and that's translating into more cardiovascular complications. I think what is most striking about our study is that the data are not surprising and really highlights that we must build cardiovascular prevention into routine pregnancy care," says Lau, a member of ACC's Reproductive Health and Cardio-Obstetrics Member Section.