Cause Of Pregnancy-related Death Research Articles

A Case for a Maternal Culturally Tailored Smoking Cessation Research Agenda

Background/Objectives: Despite national efforts, smoking rates during pregnancy remain high among certain demographics, particularly American Indian/Alaska Native and younger women. This study examines the causal link between maternal smoking, maternal and fetal mortality, and social determinants of health, highlighting disparities faced by Black, Indigenous, and People of Color (BIPOC) and American Indian/Alaskan Native (AIAN) pregnant persons. Methods: Data from various sources, including national reports and committee findings, were analyzed to assess trends in maternal smoking, mortality rates, and associated factors. While smoking rates among all groups have declined, disparities persist. Young women, BIPOC, and American Indian/Alaska Native women, and those with lower educational attainment, have higher smoking rates. Black women exhibit significantly higher maternal mortality rates, often linked to cardiac/coronary conditions. Stress, exacerbated by social determinants of health like poverty and housing insecurity, emerges as a key factor driving smoking behavior, particularly among African Americans. The leading causes of pregnancy-related deaths vary by race and ethnicity, with preventability noted in 80% of cases. Perinatal exposure to cigarette smoking is also identified as a leading cause of poor infant health outcomes, emphasizing the importance of addressing smoking behavior during and after pregnancy. Results: This report advocates for a comprehensive approach to reducing maternal and fetal mortality rates, with a focus on adapting existing smoking cessation programs to adopt culturally tailored agendas in order to address social and political determinants of health as well as behavioral drivers of tobacco use among pregnant persons.

Virtual Obstetric Emergency Simulations: Enhancing Knowledge, Skills, and Confidence of Emergency Medicine and Obstetric Professionals.

Between 2008 and 2016, 23% of pregnancy-related deaths in Ohio occurred in an emergency department (ED) or outpatient setting. Prior research showed that 98% of Ohio's delivery hospitals conduct obstetric (OB) emergency simulations, whereas only 30% include ED staff. The goal of the grant was to increase the knowledge, skill, and self-efficacy of emergency medicine (EM) professionals in managing OB emergencies. In addition to EM professionals, there was high interest by obstetrics and gynecology (OB/GYN) and other professionals in the course. Therefore, the goal of the project was to increase these elements for all professionals including EM and non-EM professionals in managing OB emergencies. Twelve virtual training courses using simulated patient encounters and video-based skills training were conducted across Ohio on the management of OB emergencies. Scenarios focused on common causes of pregnancy-related death using data from the Ohio Pregnancy-Associated Mortality Review Committee. Pre- and posttests assessed training effectiveness. Between August 1, 2020, and June 30, 2023, 258 learners completed the course. Most were female (76.76%), White (90.61%), and under 45 years old (69.40%). Most (66.49%) were from EM, followed by OB/GYN (18.09%), and other specialties (15.43%) including family medicine and pediatric EM. Most worked in hospital settings (89.19%). Learners reported a median 10.00 (interquartile range [IQR]: 15.00) years in clinical practice. Overall, mean knowledge scores increased by 0.81 (95% confidence interval [CI]: 0.62, 1.01), after the course (p < 0.001). Mean knowledge scores increased by 0.90 (95% CI: 0.64, 1.16; p < 0.001), 0.67 (95% CI: 0.24, 1.09; p = 0.003), and 0.60 (95% CI: 0.16, 1.04; p = 0.01) for those from EM, OB/GYN, and other specialties, respectively. Median scores for reported self-efficacy increased by 24.00 (IQR: 22.33) and self-reported skills increased by 30.42 (IQR: 22.83) points (p < 0.001). Virtual simulations can be effective in improving EM, OB, and other professionals' knowledge, self-efficacy, and self-reported skills in managing OB emergencies. · Obstetric knowledge and skills can be taught effectively in a virtual environment.. · Educational interventions can use pregnancy-associated mortality data to target local patterns.. · Simulation can teach management of high-acuity, low-frequency obstetric emergencies to learners..

Reproductive Justice: A Framework for Improving Maternal Mental Health

The United States has the highest rate of maternal deaths compared to any high-income country, with the highest rate for Black women. Mental health conditions such as Perinatal Mood and Anxiety Disorders (PMAD) are the most common complication during the perinatal period and the leading cause of pregnancy-related death in the U.S. Nurses following a Reproductive Justice framework can improve perinatal mental health outcomes. The purpose of this article is to review the current maternal mental health crisis through the lens of the Reproductive Justice movement. By utilizing the three Reproductive Justice principles as a framework, this article will identify action steps that nurses can take today to help create a culture of health for mothers and babies.

Pregnancy-Related Deaths Due to Hemorrhage: Pregnancy Mortality Surveillance System, 2012-2019.

Hemorrhage has been a leading cause of pregnancy-related death in the Centers for Disease Control and Prevention Pregnancy Mortality Surveillance System since 1987 when reporting began. Pregnancy Mortality Surveillance System data from 2012 to 2019 were analyzed to describe pregnancy-related deaths from hemorrhage. Pregnancy-related mortality ratios were estimated for hemorrhage overall and by hemorrhage subclassifications. Specific subclassifications of hemorrhage-related deaths were analyzed by sociodemographic characteristics. Overall, there were 606 deaths due to hemorrhage. The pregnancy-related mortality ratio for hemorrhage overall was 1.94 per 100,000 live births. Ruptured ectopic pregnancy was the most frequent subclassification (22.9%) of pregnancy-related hemorrhage deaths, followed by postpartum hemorrhage (21.2%). There were no significant trends in the pregnancy-related mortality ratio, overall or among any subclassification of hemorrhage deaths, from 2012 to 2019. Reporting subclassifications of pregnancy-related hemorrhage deaths could improve the ability to focus interventions and assess progress over time.

Tranexamic Acid to Prevent Obstetrical Hemorrhage After Cesarean Delivery

(N Engl J Med 2023;388(15):1365–1375) Postpartum hemorrhage is the second leading cause of pregnancy-related death in the United States, and accounts for up to 27.1% of global maternal deaths. Tranexamic acid has been previously associated with a reduction in overall mortality in several different settings, but majorly in obstetrical contexts. Research has not discovered, however, if the use of tranexamic acid is beneficial when it comes to its prophylactic use to prevent significant blood loss after birth or related other outcomes such as incidence of blood transfusion products or need for additional intervention to control bleeding. This study was a randomized trial to assess the effectiveness of tranexamic acid administered immediately after umbilical cord clamping in reducing the risk of maternal death or blood transfusion compared to placebo.

Listening to Black Pregnant and Postpartum People: Using Technology to Enhance Equity in Screening and Treatment of Perinatal Mental Health and Substance Use Disorders.

Perinatal mood and anxiety disorders (PMADs), perinatal substance use disorders (PSUDs), and intimate partner violence (IPV) are leading causes of pregnancy-related deaths in the United States. Screening and referral for PMADs, PSUDs and IPV is recommended, however, racial disparities are prominent: Black pregnant and postpartum people (PPP) are less likely to be screened and attend treatment compared to White PPP. We conducted qualitative interviews to better understand the experience of Black PPP who used a text/phone-based screening and referral program for PMADs/PSUDs and IPV-Listening to Women and Pregnant and Postpartum People (LTWP). We previously demonstrated that LTWP led to a significant reduction in racial disparities compared to in-person screening and referral, and through the current study, sought to identify facilitators of PMAD/PSUD symptom endorsement and treatment attendance. Semi-structured interviews were conducted with 68 Black PPP who were or had been pregnant within the last 24 months, and who either had or did not have a PMAD or PSUD. Participants were enrolled in LTWP and provided feedback on their experience. Using a grounded theory approach, four themes emerged: usability, comfort, necessity, and recommendations. Ease of use, brevity, convenience, and comfort in discussing mental health and substance use via text were highlighted. Need for a program like LTWP in Black communities was discussed, given the reduction in perceived judgement and access to trusted information and resources for PMADs/PSUDs, which may lessen stigma. These qualitative findings illuminate how technology-based adaptations to behavioral health screening and referral can reduce perceived negative judgment and facilitate identification and referral to treatment, thereby more adequately meeting needs of Black PPP.

A Comparison of Two Statewide Datasets to Understand Population Prevalence of Substance Use in Pregnancy: Findings and Considerations for Policy & Research.

Mental health conditions including substance use disorder are the leading cause of pregnancy-related deaths in the U.S. Unfortunately, fears of child protective services' involvement interfere with maternal self-disclosure of substance use in pregnancy. Seeking to identify more mothers with substance use disorder in pregnancy or at delivery, and responsive to changes to the federal Child Abuse Prevention and Treatment Act (CAPTA), Connecticut requires hospital personnel to submit a deidentified notification to CPS for all newborns with prenatal substance exposure. However, it is unknown whether this approach aligns with maternal self-report on substance use. For the present study, we compared population parameters derived from CAPTA notifications submitted between March-December 2019 with parameters derived from self-report data on substance use in pregnancy from mothers who gave birth during the same timeframe. Results revealed that three times as many mothers self-reported any alcohol or drug use in pregnancy compared to the rate measured with CAPTA notifications. Compared to mothers who self-reported drug use in the third trimester, CAPTA notifications were made for statistically similar rates of Black mothers but half the self-reported rate of White and Hispanic mothers. This disparity reflects that CAPTA notifications were made for twice as many Black mothers as White or Hispanic. Although CAPTA notifications are not punitive in nature, this disparity reveals that the public health aims of this policy are not yet achieved.

High-throughput methylome analysis reveals differential methylation for early and late onset preeclampsia for mothers and their children.

Preeclampsia is a hypertensive disorder of pregnancy that affects ∼2%-5% of all pregnancies, contributes to 4 of the top 10 causes of pregnancy-related deaths, and remains a long-term risk factor for cardiometabolic diseases. Yet, little is still known about the molecular mechanisms that lead to this disease. There is evidence that some cases have a genetic cause. However, it is well appreciated that harmful factors in the environment, such as poor nutrition, stress, and toxins, may lead to epigenetics changes that can contribute to this disease. DNA methylation is one of the epigenetic modifications known to be fairly stable and impact gene expression. Using DNA from buccal swabs, we analyzed global DNA methylation among three groups of individuals: mothers who experienced 1) early-stage preeclampsia (<32 wk), 2) late-stage preeclampsia (>37 wk), or 3) no complications during their pregnancies, as well as the children from these three groups. We found significant differentially methylated regions (DMRs) between mothers who experienced preeclampsia compared with those with no complications adjacent or within genes that are important for placentation, embryonic development, cell adhesion, and inflammation (e.g., the cadherin pathway). A significant portion of DMR genes showed expression in tissues relevant to preeclampsia (i.e., the brain, heart, kidney, uterus, ovaries, and placenta). As this study was performed on DNA extracted from cheek swabs, this opens the way to future studies in different tissues, aimed at identifying possible biomarkers of risk and early detection, developing targeted interventions, and reducing the progression of this life-threatening disease.NEW & NOTEWORTHY Preeclampsia is a life-threatening hypertensive disorder, affecting 2%-5% of pregnancies, that remains poorly understood. This study analyzed DNA methylation from buccal swabs from mothers who experienced early and late-stage preeclampsia and those with uncomplicated pregnancies, along with their children. Differentially methylated regions were found near and within genes crucial for placental function, embryonic development, and inflammation. Many of these genes are expressed in preeclampsia-related tissues, offering hope for future biomarker development for this condition.

Overview of findings in patients with ectopic pregnancy: case report

Background: Ectopic pregnancy is the implantation of a fertilized egg outside the endometrial cavity of the uterus. Ectopic pregnancy is the leading cause of pregnancy-related death in the first trimester, accounting for 75% of maternal deaths in the first trimester and 9% to 13% of all pregnancy-related deaths. In the diagnosis of ectopic pregnancy, elevated serum levels of human chorionic gonadotropin (Beta-HCG) and uterine changes at early sonography are early indications for diagnostics. Magnetic resonance imaging (MRI) plays an important role in diagnosing and managing cases where ultrasound is inconclusive or when more accurate information is needed to make a proper diagnosis or to guide clinical management. Case Description: There was a 30-year-old female patient with a diagnosis of G1P1A0 at 10-11 weeks gestation who came with complaints of bleeding from the vagina. In these patients, physical examination and laboratory were examined, followed by radiological examinations with transvaginal ultrasound (TVUS) and MRI, and confirmed by histopathology study. Conclusion: MRI is not used conventionally in the diagnosis of ectopic pregnancy but can be an additional imaging modality for ultrasound. MRI is an effective diagnostic imaging alternative in cases where sonography is inconclusive or when more precise information is needed to diagnose properly or guide clinical and surgical management.

Peripartum Cardiac Arrest with Terminal QRS Distortion: A Case Report.

Peripartum cardiac arrest is increasing in incidence. While pulmonary embolism (PE) remains an important cause of peripartum morbidity and mortality, other cardiovascular emergencies such as myocardial infarction (MI) are now the leading cause of pregnancy-related death. Emergency physicians (EP) need to be well versed in subtle electrocardiographic (ECG) signs of coronary ischemia to better care for peripartum patients in cardiac arrest. A 38-year-old gravida 2 parity1 female three days post-partum presented in cardiac arrest. After approximately 12minutes of Advanced Cardiac Life Support including electric defibrillation, the patient experienced sustained return of spontaneous circulation. The physician team was primarily concerned for PE based on an initial ECG demonstrating terminal QRS distortion in V2 but no ST-segment elevation myocardial infarction (STEMI). Computed tomography angiography (CTA) of the chest did not reveal PE. Repeat ECG after CTA demonstrated STEMI criteria, and the patient was emergently taken to the cardiac catheterization laboratory where she was found to have 99% occlusion of the left anterior descending artery. Emergency physicians should have a high index of suspicion for MI when managing peripartum patients in cardiac arrest. The ECG findings specific for coronary-occlusive acute MI but not included in the classic STEMI criteria increase accuracy and prevent delays in diagnosis; however, the clinical uptake of this paradigm has been slow. Early recognition of terminal QRS distortion can help EPs more rapidly diagnose the etiology of cardiac arrest.

Pregnancy-related mortality in the United States from 2018 to 2020

BackgroundMaternal reproductive health is facing significant challenges in the United States. Currently, the nation has the highest maternal death rate among high-income countries, and the rate continues to increase. Recent United States data indicate that 80% of maternal deaths are preventable, highlighting the urgent need for action on this critical issue. MethodsWe analyzed United States national death certificate data and birth data from the CDC's wide-ranging online data for epidemiologic research databases. We estimated pregnancy-related mortality rates by state, age group and race, and ethnicity. We assessed cause-specific pregnancy-related mortality and late maternal death (i.e., deaths occurring >42 days and up to 1-year post-pregnancy). ResultsDuring 2018–2020, we observed 3364 pregnancy-related deaths, including 1006 late maternal deaths. The age-standardized mortality rate (ASR) increased by 37.2% from 25.4 (95% CI: 23.8–26.9) per 100,000 live births in 2018–34.7 (95% CI: 32.8–36.5) in 2020. Rates ranged from 16.8 per 100,000 to 57.5 per 100,000. If the national rate was reduced to the lowest state rate, 1448 pregnancy-related deaths could have been avoided. The rate among non-Hispanic Black people (ASR2018–2020 = 70.7 per 100,000) was two to three times higher than other groups estimated. Cardiovascular conditions are the leading cause of pregnancy-related deaths overall, yet cancer was associated with 20% of late maternal death. Mental and behavioral disorders and drug and alcohol-induced death were also important contributors to late maternal death. ConclusionsWe observed alarming trends of increasing pregnancy-related death rates in the United States. Our study provides important insights for identifying opportunities to reduce avoidable maternal deaths.

Perinatal Substance Use Disorder Learning Collaborative

In their most recent legislative report, the Washington State Maternal Mortality Review Panel found that one of the leading causes of pregnancy-related deaths were behavioral health conditions, including suicide and overdose, and opioids were involved in most of the pregnancy-associated accidental overdose cases.

Status of Maternal Cardiovascular Health in American Indian and Alaska Native Individuals: A Scientific Statement From the American Heart Association.

Cardiovascular disease is the leading cause of pregnancy-related death in the United States. American Indian and Alaska Native individuals have some of the highest maternal death and morbidity rates. Data on the causes of cardiovascular disease-related death in American Indian and Alaska Native individuals are limited, and there are several challenges and opportunities to improve maternal cardiovascular health in this population. This scientific statement provides an overview of the current status of cardiovascular health among American Indian and Alaska Native birthing individuals and causes of maternal death and morbidity and describes a stepwise multidisciplinary framework for addressing cardiovascular disease and cerebrovascular disease during the preconception, pregnancy, and postpartum time frame. This scientific statement highlights the American Heart Association's factors for cardiovascular health assessment known collectively as Life's Essential 8 as they pertain to American Indian and Alaska Native birthing individuals. It summarizes the impact of substance use, adverse mental health conditions, and lifestyle and cardiovascular disease risk factors, as well as the cascading effects of institutional and structural racism and the historical trauma faced by American Indian and Alaska Native individuals. It recognizes the possible impact of systematic acts of colonization and dominance on their social determinants of health, ultimately translating into worse health care outcomes. It focuses on the underreporting of American Indian and Alaska Native disaggregated data in pregnancy and postpartum outcomes and the importance of engaging key stakeholders, designing culturally appropriate care, building trust among communities and health care professionals, and expanding the American Indian and Alaska Native workforce in biomedical research and health care settings to optimize the cardiovascular health of American Indian and Alaska Native birthing individuals.

Unmet Need for Safe Contraceptive Use Among Hypertensive Women at Risk for Unintended Pregnancy [ID: 1376928

INTRODUCTION: The prevalence of hypertension among reproductive-aged women in the United States is increasing, and hypertension increases risks of adverse pregnancy and fetal outcomes. Cardiovascular events are the leading cause of pregnancy-related death in the United States. Therefore, contraceptive counseling should be an essential aspect of hypertension management. Our objective was to compare contraceptive counseling and use among hypertensive and nonhypertensive people at risk of unintended pregnancy. METHODS: Using the 2015–2017 and 2017–2019 National Survey of Family Growth (NSFG) Female Respondent Files, we compared contraceptive counseling and contraceptive use in the previous 12 months among people with and without hypertension. Linear probability models were used to estimate the adjusted probability of receiving contraceptive counseling and using contraception. RESULTS: Among 8,625 participants, 771 (8.7%) were hypertensive. 26.2% (95% CI 20.4–31.9) with hypertension and 20.7% (95% CI 19.3–22.2) without hypertension reported receiving contraceptive counseling. 39.8% (95% CI 33.2–46.5) with and 35.3% (95% CI 33.3–37.2) without hypertension reported using contraception. Adjusted results indicate hypertensive participants were 8.0% (95% CI 2.4–13.6) more likely to receive counseling, and 9.4% (95% CI 2.7–16.1) more likely to receive birth control. The most used contraceptive method by hypertensive participants was combined oral contraceptive pills (54.0% [95% CI 44.3–63.5%]). CONCLUSION: Among people at risk for unintended pregnancy, only 26.2% with hypertension received contraceptive counseling, and less than 40% used a contraceptive method. These results illuminate a large, unmet need for contraceptive access. Given the association of hypertension and maternal health, improving contraceptive delivery to this group provides an opportunity to prevent pregnancy-related morbidity.

Effect of Insurance Status on the Length of Time to Readmission for Postpartum Preeclampsia [ID: 1377910

INTRODUCTION: Maternal statistics show us that the majority of maternal morbidity and mortality occur postpartum, with a higher rate of morbidity and mortality in those without private insurance. Hypertensive disorders of pregnancy remain a significant cause of pregnancy-related death, and preeclampsia was found to account for 82% of the readmissions at our community-based hospital. Timely diagnosis of preeclampsia can prevent further morbidity and mortality. A retrospective cohort study was conducted to determine whether insurance status has an effect on length of time until diagnosis of preeclampsia requiring postpartum readmission. METHODS: All patients with deliveries and postpartum readmissions from January 1, 2018 to December 31, 2020, were included in the study at Saint Peters University Hospital in New Brunswick, New Jersey, with IRB approval. Data were obtained from the Paragon Electronic Medical Record, including the patient insurance status (private or service-Medicaid, Medicaid HMO, self-pay), race, ethnicity, age, length of admission and readmission, as well as length of time between the delivery admission to readmission. Institutional board review committee approval was obtained for this study. RESULTS: A total of 15,509 patients were delivered between 2018 and 2020 with 149 (0.96%; 149/15,509) patients readmitted for hypertensive disorders of pregnancy. The study showed that patients with private insurance were readmitted on average in 4.54+3.42 days after their delivery admission, whereas those without private insurance were admitted on average 6.30+4.91 days after delivery admission (P=.010). CONCLUSION: In this community-based hospital, patients with private insurance who were readmitted for preeclampsia were diagnosed and readmitted for treatment in a shorter period of time than those without private insurance.

Maternal Mortality in the United States: Trends and Opportunities for Prevention

Maternal mortality is unusually high in the United States compared to other wealthy nations and is characterized by major disparities in race/ethnicity, geography, and socioeconomic factors. Similar to other developed nations, the United States has seen a shift in the underlying causes of pregnancy-related death, with a relative increase in mortality resulting from diseases of the cardiovascular system and preexisting medical conditions. Improved continuity of care aimed at identifying reproductive-age women with preexisting conditions that may heighten the risk of maternal death, preconception management of risk factors for major adverse pregnancy outcomes, and primary care visits within the first year after delivery may offer opportunities to address gaps in medical care contributing to the unacceptable rates of maternal mortality in the United States.

Physician's Knowledge and Practices Surrounding Low-Dose Aspirin for Preeclampsia Risk Reduction.

Preeclampsia is a leading cause of pregnancy-related deaths. Up to 60% of maternal deaths associated with preeclampsia may be prevented. Clinical trials have shown that low-dose aspirin reduces preeclampsia up to 30% among women at increased risk. Since 2014, multiple professional societies and the U.S. Preventive Services Task Force have released guidelines on the use of low-dose aspirin to reduce the risk of preeclampsia. We aimed to evaluate physician's knowledge and practices surrounding low-dose aspirin for preeclampsia risk reduction. We distributed an anonymous electronic survey to licensed physicians in the Rio Grande Valley of Texas who provide prenatal care, including general obstetrician-gynecologists, maternal fetal medicine subspecialists, and family medicine physicians. The survey consisted of 20 items assessing demographics, provider practices, and knowledge on the use of low-dose aspirin for preeclampsia risk reduction. We received 48 surveys with a response rate of 55%. More than 90% of physicians reported recommending low-dose aspirin for preeclampsia risk reduction, of which 98% correctly identified the dose. Of the physicians recommending aspirin, 83% initiate dosing between 12 and 16 weeks, but only 52% continue it until the day of delivery. Nearly 80% of respondents identified that one high-risk factor for preeclampsia is an indication for prophylaxis, but only 56% identified that two or more moderate risk factors should prompt aspirin recommendation. Despite clear professional guidelines, physicians demonstrated gaps in knowledge and differences in practices. Enhancing screening tools to assess patient's risk of developing preeclampsia and tailored medical education on moderate risk factors are needed to identify patients who may benefit from this intervention. Increasing the use of aspirin in patients at risk is critical given the benefits of low-dose aspirin in the reduction of poor maternal and neonatal outcomes related to preeclampsia. · Low-dose aspirin reduces preeclampsia in patients up to 30%.. · Physicians have gaps in knowledge despite guidelines.. · Following guidelines reduces poor outcomes associated with preeclampsia..

Alliance for Innovation on Maternal Health: Consensus Bundle on Cardiac Conditions in Obstetric Care.

Cardiac conditions are the leading cause of pregnancy-related deaths and disproportionately affect non-Hispanic Black people. Multidisciplinary maternal mortality review committees have found that most people who died from cardiac conditions during pregnancy or postpartum were not diagnosed with a cardiovascular disease before death and that more than 80% of all pregnancy-related deaths, regardless of cause, were preventable. In addition, other obstetric complications, such as preeclampsia and gestational diabetes, are associated with future cardiovascular disease risk. Those with cardiac risk factors and those with congenital and acquired heart disease require specialized care during pregnancy and postpartum to minimize risk of preventable morbidity and mortality. This bundle provides guidance for health care teams to develop coordinated, multidisciplinary care for pregnant and postpartum people with cardiac conditions and to respond to cardio-obstetric emergencies. This bundle is one of several core patient safety bundles developed by the Alliance for Innovation on Maternal Health that provide condition- or event-specific clinical practices for implementation in appropriate care settings. The Cardiac Conditions in Obstetric Care bundle is organized into five domains: 1) Readiness , 2) Recognition and Prevention , 3) Response , 4) Reporting and Systems Learning , and 5) Respectful Care . This bundle is the first by the Alliance to be developed with the fifth domain of Respectful Care . The Respectful Care domain provides essential best practices to support respectful, equitable, and supportive care to all patients. Further health equity considerations are integrated into elements in each domain.

Cardiac disease and risk of hypertensive disorders of pregnancy

Cardiovascular disease affects 1-4% of US pregnancies and is the leading cause of pregnancy related deaths. There are limited data on rates of hypertensive disorders of pregnancy (HDP) in this population. ACOG and USPSTF guidelines for aspirin (ASA) use for reduction of preeclampsia (PEC) do not include cardiac disease in the high or moderate risk categories. Our objective was to determine if cardiovascular disease is a risk factor for developing HDP. This was a retrospective cohort study of pregnancies complicated by maternal cardiac disease at a single academic center between 2018 and 2022. Patients with cardiac disease (congenital or acquired) who delivered after 20 weeks were included. For patients with multiple pregnancies during the timeframe, only the first pregnancy was included. Patient demographics and pregnancy outcomes were recorded. The primary outcome was development of HDP. Secondary outcomes were correlation of HDP with presence of one high or two moderate risk factors based on ACOG guidelines for ASA use and severity of cardiac disease based on modified World Health Organization (mWHO) risk class. 115 patients were included. Demographic and outcomes are shown in Table 1. 18 (15.7%) patients developed HDP and 71 patients (61.7%) were on ASA. Among the 18 patients with HDP, 55% developed PEC with severe features and 44% developed PEC post-partum. HDP was associated with multiple gestations (p< 0.01), age (p=0.04) and the combination of one high risk or two moderate risk factors for PEC (p=0.03). mWHO class was not associated with development of HDP (p=0.86). It has not been established if cardiac disease in pregnancy is an independent risk factor for developing PEC. Our study reveals high rates of HDP in this cohort (15.7% in our population compared to CDC rate of 4% of US pregnancies), even in the setting of ASA use and regardless of mWHO risk class. While more research is needed, based on our data it would be reasonable to offer patients with cardiac disease ASA for prevention of PEC.

Patient-Friendly Summary of the ACR Appropriateness Criteria: Suspected Pulmonary Embolism: 2022 Update.

Pulmonary embolism (PE) occurs because of a sudden blockage of a lung artery. PE is the third most common cardiovascular disease and a leading cause of pregnancy-related death. Not all cases of PE are fatal. PE usually occurs with deep vein thrombosis, which is a blood clot in a deep vein, such as in the leg. PE can be hard to identify, as symptoms of chest pain and shortness of breath are common among cardiovascular diseases. Various clinical criteria can be used to assess an individual’s risk for PE.