Comparison of severe maternal morbidity in pregnancy by modified World Health Organization Classification of maternal cardiovascular risk

To compare rates of severe maternal morbidity (SMM) for pregnant patients with a cardiac diagnosis classified by the modified World Health Organization (mWHO) classification to those without a cardiac diagnosis. This retrospective study using the 2015-2019 Nationwide Readmissions Database identified...

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Bibliographic Details
Published in:The American heart journal 2022-08, Vol.250, p.11-22
Main Authors: Denoble, Anna E., Goldstein, Sarah A., Wein, Lauren E., Grotegut, Chad A., Federspiel, Jerome J.
Format: Article
Language:English
Subjects:
Age
Cardiovascular disease
Cardiovascular diseases
Cardiovascular Diseases - epidemiology
Classification
Codes
Comorbidity
Congenital diseases
Coronary artery disease
Datasets
Death
Diagnosis
Disease control
Female
Health risks
Heart
Heart Disease Risk Factors
Heart diseases
Hospitalization
Hospitals
Humans
Maternal mortality
Morbidity
Mortality
Obstetrics
Postpartum
Pregnancy
Retrospective Studies
Risk
Risk Factors
Womens health
World Health Organization
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Summary:To compare rates of severe maternal morbidity (SMM) for pregnant patients with a cardiac diagnosis classified by the modified World Health Organization (mWHO) classification to those without a cardiac diagnosis. This retrospective study using the 2015-2019 Nationwide Readmissions Database identified hospitalizations, comorbidities, and outcomes using diagnosis and procedure codes. The primary exposure was cardiac diagnosis, classified into low-risk (mWHO class I and II) and moderate-to-high-risk (mWHO class II/III, III, or IV). The primary outcome was SMM or death during the delivery hospitalization; secondary outcomes included cardiac-specific SMM during delivery hospitalizations and readmissions after the delivery hospitalization. A weighted national estimate of 14,995,122 delivery admissions was identified, including 46,541 (0.31%) with mWHO I-II diagnoses and 37,330 (0.25%) with mWHO II/III-IV diagnoses. Patients with mWHO II/III-IV diagnoses experienced SMM at the highest rates (22.8% vs 1.6% for no diagnosis; with adjusted relative risk (aRR) of 5.67 [95% CI: 5.36-6.00]). The risk of death was also highest for patients with mWHO II/III-IV diagnoses (0.3% vs
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2022.04.009