Pregnancy Outcomes in Women With Cardiovascular Disease:A Retrospective Cohort Study from Kaiser Permanente Northern...

Cardiovascular disease (CVD) remains a leading cause of maternal mortality in the United States, comprising 26.5% of pregnancy-related deaths. We sought to evaluate trends in CVD during pregnancy and maternal, obstetric, and fetal outcomes in pregnant women with CVD in the Kaiser Permanente Northern California (KPNC) integrated healthcare system. This retrospective cohort study included adult KPNC members with moderate or greater valvular heart disease, cardiomyopathy, congenital heart disease, or ischemic heart disease during pregnancy from 2010 to 2021. Bivariate analyses and multivariable logistic regression were used to evaluate associations between demographic and clinical risk factors and maternal outcomes in pregnant patients with CVD. Of 320,902 pregnancies, 763 (0.24%) were identified with clinically significant CVD. The prevalence of CVD increased from 0.19% to 0.34% over the decade, predominantly due to an increase in prevalence of women with congenital heart disease. Mean gestational age at delivery was 36.7 weeks with 19.5% experiencing preterm delivery. Cesarean section, pre-eclampsia or eclampsia, and postpartum hemorrhage rates were 29.5%, 20.8%, and 9.7%, respectively. Fetal loss beyond the first trimester occurred in 7.1% pregnancies. Adverse maternal cardiac outcomes occurred in 55 (7.2%) of patients, predominantly driven by congestive heart failure hospitalizations. There were 4 deaths (0.5%) during pregnancy or within 1 year postpartum. Pre-existing CVD (aOR 0.20, p = 0.002) and cardiac medication use (aOR 4.13, p <0.001) were significant predictors of adverse maternal outcomes. Higher left ventricular ejection fraction (aOR 0.95, p = 0.018) was associated with lower odds of adverse maternal outcomes. In conclusion, understanding risk factors for adverse pregnancy outcomes in a diverse, contemporary population of patients with CVD can help refine cardio-obstetric risk assessment and preconception counseling.