Heart Disease Among Pregnant Women in the United States: Data, Challenges, and Opportunities for Collaboration

Cardiovascular diseases are among the leading causes of maternal morbidity and mortality in the United States. During 2010-2020, 1 in 10 severe maternal morbidities (SMMs) during delivery hospitalization was heart disease (HD)-related. This report synthesizes science, including methodologies, challenges, and opportunities, and summarizes national estimates on HD during pregnancy, focusing on congenital heart disease (CHD), cardiomyopathies (CM), valvular heart disease (VHD), arrhythmias (ARR), and heart failure (HF).

We analyzed large nationwide databases, including the National Inpatient Sample and the Nationwide Readmissions Database. The prevalence of HD complicating deliveries ranges from approximately 20-40 cases per 10,000 deliveries. Increasing trends were observed in CHD, ARR, and HF. HF, particularly peripartum CM, is a leading cause of adverse maternal outcomes, including in-hospital mortality and SMM. VHD prevalence has declined, whereas ARR has become the most prevalent HD during pregnancy hospitalizations. Significant gaps exist due to inconsistent definitions and methodologies, limiting comparability and clinical utility. Proposed solutions include adopting standardized definitions, developing a core outcome set, improving data quality through structured documentation and standardized data models, and using validated algorithms and indices. Collaboration among multidisciplinary teams is essential to enhance research quality.

The efforts aligning definitions of HD, outcomes, and indices with public health measures and initiatives present an opportunity to create a unifying framework that connects patient-level data to system-wide improvements. This integration helps ensure that advances in methodology translate into better care delivery, billing accuracy, research quality, and public health surveillance, and ultimately enhance outcomes for pregnant women with HD.