Cardiac and vascular complications cause one-third of maternal deaths in the United States. Pregnant women with preexisting cardiovascular diseases experience a greater risk of cardiovascular complications during pregnancy. Despite these known facts, analyses of incidences and trends of cardiovascular complications during pregnancy performed in large cohorts in multiple health centers over decades were missing. To address this gap, Lau et al. conducted a study, published in Circulation to “quantify the scope and trajectory of the problem across a large, real-world health system, including the critical postpartum year.” Emily Lau told us that they were motivated by what they were seeing at the bedside: “more patients entering pregnancy with hypertension, diabetes and obesity — and a growing number experiencing cardiovascular complications during and after pregnancy.” The researchers’ goal with this study was to “generate actionable evidence that can inform earlier risk identification, build prevention into routine prenatal care and strengthen transitions to cardiology follow-up after delivery, helping health systems design the right interventions for the right patients at the right time.”
The researchers established PADME (predictive analysis with deep learning models for maternal endpoints), an electronic health record (EHR)-based pregnancy cohort that uses data from 56,833 pregnancies and 38,996 women who received primary care between 2001 and 2019 in one of 11 tertiary care and community hospitals in New England. Of these pregnancies, 12% occurred in the context of preexisting obesity, 3% of preexisting diabetes, 8% of preexisting hypertension, and 10% of preexisting hyperlipidemia. The researchers grouped the pregnant women according to their age: 18–25 years, 26–35 years, 35–40 years and above 40 years. They observed that the prevalence of obesity, hypertension, hyperlipidemia and diabetes increased between 2001 and 2019 in most of the age-related groups: maternal obesity increased from 2% in 2001 to 16% in 2019, diabetes from 1% to 3%, hypertension from 3% to 12% and hyperlipidemia from 3% to 10%. Non-Hispanic, Black women showed the highest prevalence of obesity, hypertension and diabetes, while white women showed the highest prevalence of hyperlipidemia. Of the PADME cohort, 4% had already suffered from preexisting maternal cardiovascular diseases (CVD) such as venous thromboembolism, heart failure and transient ischemic heart attacks. The prevalence of established maternal CVDs was lowest in the youngest group and highest in the oldest group, especially in Black and white women, and it increased from 1% in 2001 to 7% in 2019.
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