Severe Cardiovascular Outcomes and Documentation of Cardiac Conditions During Delivery Hospitalizations and Postpartum, Georgia, 2016-2023
Abstract
Background: Cardiovascular conditions are among the leading causes of pregnancy-related deaths, and most cardiovascular deaths occur postpartum. Among those deaths, half of cardiovascular conditions are diagnosed at autopsy. Non-fatal severe maternal morbidity (SMM) occurs at high rates among pregnant/postpartum women with documented existing cardiac conditions (DECC) and those who are non-Hispanic (NH) Black. To support Georgia cardiovascular screening efforts, we sought to describe DECC overall and among women with cardiovascular SMM during Georgia delivery hospitalizations and postpartum, by race/ethnicity.
Methods: We linked 954,204 Georgia delivery hospitalization (DH) discharge records for 1/1/2016 through 10/8/2023 with postpartum (12 weeks following delivery) hospitalization and emergency room records. Using American College of Obstetricians and Gynecologists’ algorithms, we examined DH and postpartum records for DECC and cardiovascular SMM indicators. We calculated the percentages and rates of DECC and used Chi-square tests to assess associations between DECC and race/ethnicity during the DH and postpartum.
Results: During DH, the rate of DECC was similar for NH Black and NH White women (139/10,000 and 138/10,000, respectively; p=0.51). Among all DHs, 1,135 women experienced cardiovascular SMM; of these, 756 (67%) had DECC. During the 12 weeks postpartum, 1,627 women experienced cardiovascular SMM. Among these, 224 (14%) had DECC during their DH, whereas 1,059 (65%) had new DECC in their postpartum hospital record. The rate of new DECC among NH Black women was 2.8 times the rate among NH White women (28/10,000 and 10/10,000, respectively; p<0.0001).
Conclusion: Our findings align with research showing that many cardiovascular complications of pregnancy are not diagnosed until postpartum. Providers should be aware of racial/ethnic disparities and educate patients on cardiovascular signs and symptoms to avoid missed opportunities and delayed diagnoses. Screening all pregnant and postpartum women for cardiovascular conditions is important to prevent cardiovascular morbidity and mortality.
Keywords
Maternal Health, Severe Maternal Morbidity, Obstetric Cardiology
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Severe Cardiovascular Outcomes and Documentation of Cardiac Conditions During Delivery Hospitalizations and Postpartum, Georgia, 2016-2023
Background: Cardiovascular conditions are among the leading causes of pregnancy-related deaths, and most cardiovascular deaths occur postpartum. Among those deaths, half of cardiovascular conditions are diagnosed at autopsy. Non-fatal severe maternal morbidity (SMM) occurs at high rates among pregnant/postpartum women with documented existing cardiac conditions (DECC) and those who are non-Hispanic (NH) Black. To support Georgia cardiovascular screening efforts, we sought to describe DECC overall and among women with cardiovascular SMM during Georgia delivery hospitalizations and postpartum, by race/ethnicity.
Methods: We linked 954,204 Georgia delivery hospitalization (DH) discharge records for 1/1/2016 through 10/8/2023 with postpartum (12 weeks following delivery) hospitalization and emergency room records. Using American College of Obstetricians and Gynecologists’ algorithms, we examined DH and postpartum records for DECC and cardiovascular SMM indicators. We calculated the percentages and rates of DECC and used Chi-square tests to assess associations between DECC and race/ethnicity during the DH and postpartum.
Results: During DH, the rate of DECC was similar for NH Black and NH White women (139/10,000 and 138/10,000, respectively; p=0.51). Among all DHs, 1,135 women experienced cardiovascular SMM; of these, 756 (67%) had DECC. During the 12 weeks postpartum, 1,627 women experienced cardiovascular SMM. Among these, 224 (14%) had DECC during their DH, whereas 1,059 (65%) had new DECC in their postpartum hospital record. The rate of new DECC among NH Black women was 2.8 times the rate among NH White women (28/10,000 and 10/10,000, respectively; p<0.0001).
Conclusion: Our findings align with research showing that many cardiovascular complications of pregnancy are not diagnosed until postpartum. Providers should be aware of racial/ethnic disparities and educate patients on cardiovascular signs and symptoms to avoid missed opportunities and delayed diagnoses. Screening all pregnant and postpartum women for cardiovascular conditions is important to prevent cardiovascular morbidity and mortality.
