OBJECTIVE To assess the risk of severe maternal morbidity (SMM) and mortality among pregnant patients with cardiovascular disease (CVD). METHODS This was a retrospective cohort study of U.S. delivery hospitalizations from 2010 to 2020 using weighted population estimates from the National Inpatient Sample database. The primary objective was to evaluate the risk of SMM and maternal mortality among patients with CVD at delivery hospitalization. International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes were used to identify delivery hospitalizations, CVD, and SMM events. Multivariable logistic regression analyses were performed to compare SMM and mortality risk among patients with CVD and those without CVD. Given the substantial racial and ethnic disparities in SMM, mortality, and CVD burden, secondary objectives included evaluating SMM and mortality across racial and ethnic groups and assessing the population attributable fraction within each group. Lastly, subgroup analyses of SMM by underlying CVD diagnoses (eg, congenital heart disease, chronic heart failure) were performed. Variables used in the regression models included socioeconomic and demographic maternal characteristics, maternal comorbidities, and pregnancy-specific complications. RESULTS Among 38,374,326 individuals with delivery hospitalizations, 203,448 (0.5%) had CVD. Patients with CVD had an increased risk of SMM (11.6 vs 0.7%, adjusted odds ratio [aOR] 12.5, 95% CI, 12.0-13.1) and maternal death (538 vs 5 per 100,000 delivery hospitalizations, aOR 44.1, 95% CI, 35.4-55.0) compared with those without CVD. Patients with chronic heart failure had the highest SMM risk (aOR 354.4, 95% CI, 301.0-417.3) among CVD categories. Black patients with CVD had a higher risk of SMM (aOR 15.9, 95% CI, 14.7-17.1) than those without CVD with an adjusted population attributable fraction of 10.5% (95% CI, 10.0-11.0%). CONCLUSION CVD in pregnancy is associated with increased risk of SMM and mortality, with the highest risk of SMM among patients with chronic heart failure. Although CVD affects less than 1% of the pregnant population, it contributes to nearly 1 in 10 SMM events in the United States.

中文翻译：

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心脏病患者与分娩相关的孕产妇发病率和死亡率。


目的 评估心血管疾病 （CVD） 妊娠患者发生严重孕产妇并发症 （SMM） 和死亡的风险。方法 这是一项回顾性队列研究，使用来自全国住院样本数据库的加权人口估计值，对 2010 年至 2020 年美国分娩住院人数进行研究。主要目的是评估 CVD 患者在分娩住院时发生 SMM 和孕产妇死亡的风险。国际疾病分类，第九版和第十版，临床修改代码用于识别分娩住院、CVD 和 SMM 事件。进行多变量 logistic 回归分析，比较 CVD 患者和无 CVD 患者的 SMM 和死亡风险。鉴于 SMM、死亡率和 CVD 负担方面的巨大种族和民族差异，次要目标包括评估不同种族和族裔群体的 SMM 和死亡率，以及评估每个群体内的人口归因部分。最后，通过潜在的 CVD 诊断 （例如，先天性心脏病、慢性心力衰竭） 对 SMM 进行亚组分析。回归模型中使用的变量包括社会经济和人口统计学孕产妇特征、孕产妇合并症和妊娠特异性并发症。结果 在 38,374,326 名住院分娩者中，203,448 名 （0.5%） 患有 CVD。与无 CVD 的患者相比，CVD 患者发生 SMM （11.6 vs 0.7%，校正比值比 [aOR] 12.5,95% CI，12.0-13.1）和孕产妇死亡 （每 100,000 例分娩住院 538 例 vs 5 例，aOR 44.1,95% CI，35.4-55.0） 的风险增加。在 CVD 类别中，慢性心力衰竭患者的 SMM 风险最高 （aOR 354.4,95% CI，301.0-417.3）。 与无 CVD 的患者相比，患有 CVD 的黑人患者发生 SMM 的风险更高 （aOR 15.9,95% CI，14.7-17.1），校正后的人群归因分数为 10.5% （95% CI，10.0-11.0%）。结论 妊娠期 CVD 与 SMM 风险和死亡率增加相关，其中慢性心力衰竭患者发生 SMM 的风险最高。尽管 CVD 影响的孕妇人口不到 1%，但它导致美国近十分之一的 SMM 事件。