Women's Heart Health Tied to Multiple Pregnancy Complication
Women with prepregnancy cardiovascular disease (CVD) risk factors have increasingly worse pregnancy outcomes, including a higher rate of maternal intensive care unit (ICU) admissions and fetal deaths, a new study suggests.

The researchers analyzed 18,646,512 pregnancies using maternal and fetal data drawn from the US National Center for Health Statistics and pooled individual-level data from births to women aged 15-44 years (mean, 28.6 years) from 2014 to 2018.

Women were categorized on the basis of having 0 to 4 prepregnancy CVD risk factors: hypertension, diabetes, self-reported smoking, and a BMI less than 18.5 kg/m2 or greater than 24.9 kg/m2. All analyses were adjusted for maternal age at delivery, race/ethnicity, education, receipt of prenatal care, parity, and birth plurality.

Over 60% of the women had one or more CVD risk factors, with 52.5% having one, 7.3% two, 0.3% three, and 0.02% four.

The association between CVD risk factors and all adverse pregnancy outcomes was dose-dependent. For instance, compared with women with no prepregnancy CVD risk factors, the risk ratios (95% CI) of maternal ICU admission were:

1.12 (1.09 - 1.15) for 1 risk factor
1.86 (1.78 - 1.94) for 2 risk factors
4.24 (3.85 - 4.68) for 3 risk factors
5.79 (4.07 - 8.23) for 4 risk factors

Compared with women without prepregnancy CVD risk factors, women with all four risk factors had significantly higher risk of all adverse outcomes:

5.8-fold higher risk for ICU admission
3.9-fold higher risk for preterm birth
2.8-fold higher risk for low birth weight
8.7-fold higher risk for fetal death

Similar results were observed in an analysis of women having their first child.

"Pregnancy health and prenatal care begin before the first trimester. This is a challenge when pregnancies are unplanned but it speaks to the larger conversation, especially in the United States, about providing access to affordable healthcare for young adults," the author said.

"We're noticing a rise in risk factors and a decreased awareness of personal cardiovascular risk, especially in this particular age group," researchers said. She added that younger women may not believe that they could be at risk of CVD.

Additionally, many external factors may place some women at a higher risk of lacking access to needed care. Compared with women with no CVD risk factors, the study found that women with one or more risk factors had, on average:

Lower educational attainment (79.5% - 85.3% vs 88.7% graduated high school)

Lower likelihood of receiving prenatal care (97.8% - 98.5% vs 98.7%)

Higher prevalence of multiparity (64.4% - 69.3% vs 56.9%)

Higher prevalence of prior spontaneous or induced pregnancy loss (27.4% - 46.0% vs 23.4%)

Further analysis of how prepregnancy CVD risk factors affect various patient demographics is needed to address health inequities, the author said.

Source: https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwab121/6322341