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Q&A

Obstetric Quality and Safety

Poster Session 4

(1065) The risk of mortality from cardiovascular disease differs depending on the mode of delivery

Wednesday, February 14, 2024

1:00 PM – 2:30 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Gabriella Lobitz, MD (she/her/hers)

Resident
Rutgers Robert Wood Johnson Medical School
New Brunswick, NJ, United States

Coauthor(s)

ER

Emily B. Rosenfeld, DO (she/her/hers)

Maternal Fetal Medicine Fellow
Robert Wood Johnson Medical School, Rutgers University
New Brunswick, NJ, United States
RL

Rachel Lee, MS

Rutgers Robert Wood Johnson Medical School
New Brunswick, NJ, United States
Deepika Sagaram, MD

Rutgers Robert Wood Johnson Medical School
New Brunswick, NJ, United States
CA

Cande V. Ananth, MPH, PhD

Professor and Vice Chair for Academic Affairs, Department of Obstetrics, Gynecology, and Reproductive Sciences
Rutgers Robert Wood Johnson Medical School
New Brunswick, NJ, United States

Objective: Cardiovascular disease (CVD) mortality is responsible for up to 22% of maternal deaths and up to 4% of pregnancies are affected by pre-existing CVD. The purpose of this study is to determine if the mode of delivery affects a person’s risk of CVD-related mortality in the year following delivery. We hypothesized that patients, both with and without prior CVD, that undergo a cesarean delivery will be at increased risk of CVD-related death.

Study Design: We designed a retrospective cohort study utilizing the Nationwide Readmissions Database (2010-2018) to identify singleton births. ICD-9 and ICD-10 codes were used to identify patients with CVD mortality within the calendar year of index delivery. Associations between mode of delivery and CVD mortality were determined from Cox proportional hazards regression models before and after adjusting for potential confounders.

Results: In persons without pre-existing CVD, CVD-related hospital mortality among the cesarean and vaginal delivery groups were 3.8 and 2.9 per 100,000 delivery discharges, respectively (hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.97, 1.46) (Figure). The risk for CVD mortality was highest in the first 30 days after the delivery hospitalization (HR 1.58, 95% CI 1.01, 2.47) and diminished with time. Risk of stroke mortality increased two-fold in the first 30 days (HR 2.11, 95% CI 1.03-4.32) and remained elevated for one year after delivery. In patients with pre-existing CVD, CVD-related mortality among the cesarean and vaginal delivery groups were 231.8 and 157.9 per 100,000 delivery discharges, respectively (HR 1.35, 95% CI 0.44, 4.14), although the risk estimate was imprecise.

Conclusion: Persons without pre-existing CVD have an increased risk of CVD-related mortality after cesarean delivery. This may be due to the unmasking of undiagnosed CVD. Mortality risk in persons with prior CVD is not affected by the mode of delivery. These findings suggest that attempting vaginal delivery among persons with and without a history of CVD may be beneficial insofar as mortality from CVD within the first year.