Outcomes of pregnancy-related hospitalizations in women with pacemakers and defibrillators

Abstract

BackgroundThere is limited information on pregnancy outcomes in women who have previously undergone implantation of cardiac implantable electronic devices (CIED). ObjectiveTo describe outcomes of pregnancy related hospitalizations in women with CIEDs. MethodsThe National Inpatient Sample database was analyzed to identify pregnancy-related hospitalizations between 2016 and 2021. ResultsWe identified 23,611,200 weighted pregnancy-related hospitalizations, out of which 11,220 (0.05%) had a history of CIED implantation. Of these, 5,105 had permanent pacemakers (PPMs) and 6,115 had implantable cardioverter-defibrillators (ICDs). The mortality rate during pregnancy-related hospitalization was significantly higher among women with ICDs (0.9%) compared to those without CIEDs (0.01%). Of note, there were no in-hospital deaths among pregnant women with PPMs. After adjusting for covariates, the excess mortality risk in women with ICDs was no longer noted. However, pregnant women with ICDs remained at higher risk of cardiogenic shock (odds ratio [OR] 3.06, 95% confidence interval [CI] 2.17-4.30) and need for mechanical circulatory support (OR 2.37, 95% CI 1.48-3.80). ConclusionIn a nationwide cohort of pregnancy-related hospitalizations, a history of CIED implantation was rare, occurring in about 0.05% of women. In-hospital mortality was significantly higher among pregnant women with ICDs. However, after adjustment for covariates, the excess mortality risk was no longer observed. Pregnant women with ICDs remain at increased risk of cardiogenic shock and need for mechanical circulatory support, even after adjusting for covariates. Outcomes for pregnant women with PPMs are generally excellent and comparable to those without CIEDs.