medRxiv : the preprint server for health sciences · 2025
Contemporary Burden of Cardiovascular Disease in Pregnancy: Insights from a Real-World Pregnancy Electronic Health Record Cohort.
СтатьяПрепринтНазвание и аннотация: Перевод в очереди
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Lau Emily S, D'Souza Valentina, Zhao Yunong, Reeder Christopher, Goldberg Rachel, Economy Katherine E, Maddah Mahnaz, Khurshid Shaan, Ellinor Patrick T, Ho Jennifer E
Аннотация
IMPORTANCE: Cardiovascular disease (CVD) is the leading cause of maternal morbidity and mortality, however the contemporary burden and secular trends in pregnancy-related CV complications are not well characterized.
OBJECTIVE: We sought to examine contemporary trends in prevalence of maternal cardiometabolic comorbidities and established CVD, as well as future pregnancy-related CV complications across a large multi-institutional health system.
DESIGN: Retrospective analysis of longitudinal electronic health record (EHR)-based cohort of pregnancies.
SETTING: Multi-institutional healthcare network in New England.
PARTICIPANTS: Pregnancy encounters between 2001 to 2019 identified using diagnosis and procedure codes followed by manual adjudication within a previously validated primary care EHR cohort. Estimated gestational ages recovered from unstructured notes using regular expressions (RegEx) were used to define individual pregnancy episodes.
MAIN OUTCOMES AND MEASURES: We quantified the prevalence of maternal cardiometabolic comorbidities and established CVD at time of pregnancy, as well as the incidence of pregnancy-related CV complications assessed within 1 year postpartum. We examined trends in cardiometabolic risk factors and CVD burden over nearly two decades.
RESULTS: Our EHR pregnancy cohort comprised 57,683 pregnancies among 38,997 individuals (mean age range at start of pregnancy 27 to 37 years). RegEx recovered gestational age for 74% of pregnancies, with good correlation between gestational age ascertained via RegEx vs manual review (Pearson r 0.9). Overall prevalence of maternal CVD was 4% (age-adjusted 7%) and increased over 19 years of follow-up (age-adjusted prevalence of maternal CVD: 1% in 2001 to 7% in 2019, p <0.001). The incidence of pregnancy-related CV complications was 15% (age-adjusted 17%) and also increased over the follow-up period (age-adjusted incidence 11% in 2001 to 14% in 2019, p <0.001). Finally, CV complications were more likely to occur in individuals with greater burden of maternal CV comorbidities and CVD (diabetes: 6% vs 3%, hypertension: 23% vs 5%, pre-existing CVD: 10% vs 3%, P<0.001 for all).
CONCLUSIONS AND RELEVANCE: Analysis of a large-scale EHR-based pregnancy cohort spanning two decades demonstrates rising prevalence of both maternal cardiometabolic comorbidities and CVD at the time of pregnancy, as well as increasing incidence of subsequent pregnancy-related CV complications. Pregnancy represents a critical opportunity for cardiometabolic health optimization.
KEY POINTS: Question: What are the contemporary real-world trends in the prevalence of maternal cardiovascular comorbidities and cardiovascular disease and incidence of cardiovascular complications in pregnancy?Findings: In an analysis of 57,683 pregnancies among 38,997 individuals from a large scale EHR-based pregnancy cohort, prevalence of maternal cardiometabolic comorbidities and cardiovascular disease and incidence of pregnancy-related cardiovascular complications increased over the course of nearly two decades.Meaning: The contemporary burden of pregnancy-related cardiovascular complications is rising at an alarming rate and highlights pregnancy as a critical opportunity for cardiovascular health optimization.
OBJECTIVE: We sought to examine contemporary trends in prevalence of maternal cardiometabolic comorbidities and established CVD, as well as future pregnancy-related CV complications across a large multi-institutional health system.
DESIGN: Retrospective analysis of longitudinal electronic health record (EHR)-based cohort of pregnancies.
SETTING: Multi-institutional healthcare network in New England.
PARTICIPANTS: Pregnancy encounters between 2001 to 2019 identified using diagnosis and procedure codes followed by manual adjudication within a previously validated primary care EHR cohort. Estimated gestational ages recovered from unstructured notes using regular expressions (RegEx) were used to define individual pregnancy episodes.
MAIN OUTCOMES AND MEASURES: We quantified the prevalence of maternal cardiometabolic comorbidities and established CVD at time of pregnancy, as well as the incidence of pregnancy-related CV complications assessed within 1 year postpartum. We examined trends in cardiometabolic risk factors and CVD burden over nearly two decades.
RESULTS: Our EHR pregnancy cohort comprised 57,683 pregnancies among 38,997 individuals (mean age range at start of pregnancy 27 to 37 years). RegEx recovered gestational age for 74% of pregnancies, with good correlation between gestational age ascertained via RegEx vs manual review (Pearson r 0.9). Overall prevalence of maternal CVD was 4% (age-adjusted 7%) and increased over 19 years of follow-up (age-adjusted prevalence of maternal CVD: 1% in 2001 to 7% in 2019, p <0.001). The incidence of pregnancy-related CV complications was 15% (age-adjusted 17%) and also increased over the follow-up period (age-adjusted incidence 11% in 2001 to 14% in 2019, p <0.001). Finally, CV complications were more likely to occur in individuals with greater burden of maternal CV comorbidities and CVD (diabetes: 6% vs 3%, hypertension: 23% vs 5%, pre-existing CVD: 10% vs 3%, P<0.001 for all).
CONCLUSIONS AND RELEVANCE: Analysis of a large-scale EHR-based pregnancy cohort spanning two decades demonstrates rising prevalence of both maternal cardiometabolic comorbidities and CVD at the time of pregnancy, as well as increasing incidence of subsequent pregnancy-related CV complications. Pregnancy represents a critical opportunity for cardiometabolic health optimization.
KEY POINTS: Question: What are the contemporary real-world trends in the prevalence of maternal cardiovascular comorbidities and cardiovascular disease and incidence of cardiovascular complications in pregnancy?Findings: In an analysis of 57,683 pregnancies among 38,997 individuals from a large scale EHR-based pregnancy cohort, prevalence of maternal cardiometabolic comorbidities and cardiovascular disease and incidence of pregnancy-related cardiovascular complications increased over the course of nearly two decades.Meaning: The contemporary burden of pregnancy-related cardiovascular complications is rising at an alarming rate and highlights pregnancy as a critical opportunity for cardiovascular health optimization.