Eclampsia and risk of postpartum readmission for cardiovascular disease in the first year after delivery

Abstract

While the link between preeclampsia and cardiovascular disease (CVD) later in life has been well studied, there has been little focus on eclampsia as a risk factor, especially for short term outcomes. We determined the risk of postpartum readmission for CVD complications in the first year after delivery following a pregnancy complicated by eclampsia. We performed a retrospective cohort study of all singleton births in the United States from 2010-2018 using the Healthcare Cost and Utilization Project Nationwide Readmissions Database. Using ICD coding, we identified all readmissions for CVD complications during the first year after delivery in patients who had eclampsia. We calculated rates of CVD readmission (per 100,000 person-months of follow-up) and expressed associations between eclampsia and CVD rehospitalization based on confounder-adjusted hazard ratio (HR) with 95% confidence interval (CI). Of a total of 33,650,229 million delivery hospitalizations, 29,502 (90 per 100,000) pregnancies were complicated by eclampsia. The median follow-up among the eclampsia and normotensive groups were 5.8 and 4.5 months, respectively. The rate of CVD readmission among the eclampsia and normotensive groups were 1736.1 and 90.6 per 100,000 person-months, respectively (adjusted HR 18.04, 95% CI 16.73, 19.46) (Table). These HRs were high for specific coronary heart disease subtype (range 6.45 to 13.19). Eclampsia was associated with substantially high risk for stroke readmissions (HR 108.97, 95% CI 96.41, 123.17). Eclampsia leads to increased risk for morbidity from CVD complications even as early as the first year following delivery. These data highlight the need to identify patients with eclampsia for targeted short-term surveillance and follow up for CVD complications.