Pregnancy-Related Differences in Cardiogenic Shock: A National Analysis of Etiology, Risk Factors, and Outcomes

Cardiogenic shock is associated with high rates of mortality in pregnancy but remains understudied.

We aim to understand the etiologies, risk factors, and outcomes of cardiogenic shock in women of childbearing age and identify whether there are pregnancy-related differences in procedural utilization.

We analyzed all delivery, pregnancy, and cardiogenic shock-related hospitalizations in reproductive-aged women (aged 18-45) using the National Inpatient Sample database (years 2016-2021).

Pregnant women with vs without cardiogenic shock had higher rates of cardiovascular comorbidities and were more likely to have preeclampsia (21.3% vs 6.5%), placental hemorrhage (26.6% vs 4.3%), fetal death (10.0% vs 0.51%), and maternal death (17.8% vs 0.01%). Comparing pregnant vs nonpregnant women with cardiogenic shock, pregnant women had lower comorbidity burden and rates of multiorgan failure but higher rates of pulmonary edema (8.9% vs 4.7%). Pregnant women with cardiogenic shock were more likely to undergo extracorporeal membrane oxygenation (adjusted OR: 1.67 [95% CI: 1.07-2.65]) and less likely to die during admission (adjusted OR: 0.43 [95% CI: 0.28-0.66]). Nonpregnant women had higher frequencies of cardiogenic shock from ischemic cardiomyopathy (CM) (25.4% vs 12.4%) and congenital heart disease (5.6% vs 1.8%), while most pregnant women had cardiogenic shock related to nonischemic CM, specifically peripartum CM (30.8%).

There are differences in cardiogenic shock etiology, comorbidities, and clinical complications among pregnant vs nonpregnant women. Findings suggest that unique pregnancy-specific factors may contribute to cardiogenic shock in pregnancy.