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Cardiovascular disease in pregnancy: Prevalence and obstetric outcomes in a Swedish population-based cohort study
Teresia Svanvik1,2, Rema Ramakrishnan2, Martin Svensson3
1Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
Insights
Cardiovascular disease in pregnancy is rising in Sweden, mainly due to arrhythmias. Diagnosis timing impacts outcomes for mothers and babies, especially in first-time mothers, highlighting the need for vigilant monitoring.
Area of Science:
- Obstetrics and Gynecology
- Cardiology
- Public Health
Background:
- Cardiovascular disease (CVD) in pregnancy, diagnosed before, during, or up to 6 months postpartum, poses risks not previously detailed in Sweden.
- This study investigates CVD prevalence trends and associated maternal/perinatal outcomes in Sweden.
Purpose of the Study:
- To analyze the trends in cardiovascular disease prevalence among pregnant women in Sweden from 2000-2019.
- To examine the association between cardiovascular disease diagnosed during pregnancy and adverse maternal and perinatal outcomes.
- To assess the impact of the timing of cardiovascular disease diagnosis (pre-pregnancy, during pregnancy, postpartum) on outcomes.
Main Methods:
- Population-based retrospective cohort study using the Swedish Medical Birth Register (2000-2019).
- Prevalence calculated as annual CVD diagnoses per pregnant woman.
- Adverse outcomes analyzed using time-dependent Cox and Poisson regression models, with follow-up up to one year postpartum.
Main Results:
- CVD prevalence in pregnant women increased from 0.31% to 1.34%, largely driven by arrhythmias.
- Primiparous women with CVD faced higher risks of eclampsia, psychiatric admission, and one-year mortality, with timing of diagnosis being significant.
- Children born to mothers with CVD had increased risks of preterm birth and being small for gestational age.
Conclusions:
- A significant rise in cardiovascular disease prevalence among pregnant women in Sweden was observed, primarily due to arrhythmias.
- The timing of cardiovascular disease diagnosis, particularly postpartum diagnosis, is critical for maternal and perinatal outcomes in primiparous women.
- Enhanced awareness and monitoring of pregnant women with CVD throughout pregnancy and postpartum are crucial for all healthcare staff.
Introduction:
The prevalence of cardiovascular disease during pregnancy (cardiovascular disease diagnosed before, during or up to 6 months after childbirth) and the risk of adverse outcomes associated with it have not been previously described in Sweden. This study examined trends in prevalence of cardiovascular disease and its association with maternal and perinatal outcomes, overall and by timing of diagnosis in relation to pregnancy.
Material And Methods:
This population-based observational retrospective cohort study consisted of women aged 15-49 years who were registered in the Swedish Medical Birth Register 2000-2019. Prevalence was defined as annual diagnosis of cardiovascular disease per pregnant woman as numerator and all pregnant women per year as denominator. Adverse maternal and perinatal outcomes were analyzed using time-dependent Cox regression and Poisson regression models. Outcomes were obtained during and after childbirth up to 1 year postpartum, depending on the outcome.
Results:
There were 2 069 107 births to 1 186 137 women (911 101 primiparous). The prevalence of cardiovascular disease among pregnant women in Sweden during 2000-2019 increased from 0.31% to 1.34%, for non-congenital cardiovascular disease, this was primarily driven by arrythmia (0.11%-0.58%). Primiparous women with cardiovascular disease had a higher risk of eclampsia over-all (aHR 4.50, 95% CI 2.01-10.05) and when diagnosed during pregnancy (aHR 3.22, 95% CI 1.21-8.61); admission to psychiatric ward overall (aHR 2.51, 95% CI 1.30-4.83), and when diagnosed during pregnancy (aHR 2.54, 95% CI 1.21-5.34); and one-year mortality when diagnosed before pregnancy (aHR 1.67, 95% CI 1.16-2.42) and when diagnosed postpartum (aHR 6.59, 95% CI 3.38-12.84), compared to those without cardiovascular disease. Children born to women with cardiovascular disease diagnosed both overall and in relation to timing of diagnosis had an increased risk of being born preterm and small for gestational age.
Conclusions:
Cardiovascular disease prevalence among pregnant women in Sweden increased during 2000-2019, primarily driven by arrhythmias. In primiparous women, the timing of diagnosis of cardiovascular disease is important for maternal and perinatal outcomes, including when diagnosed postpartum. This calls for awareness among all staff when planning pregnancy and monitoring women with cardiovascular disease throughout pregnancy and in the postpartum period.
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