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Medical/Surgical/Diseases/Complications

Poster Session 2

(426) Brain natriuretic peptide testing and severe maternal morbidity in pregnancies affected by heart disease

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

We aimed to describe patterns of brain natriuretic peptide (BNP) testing and levels prior to delivery hospitalization among pregnant patients with and without heart disease, and the association between BNP and severe maternal morbidity (SMM).

Study Design: This retrospective cohort study included a nationwide sample of pregnant patients in EPIC Cosmos from 2018-2022 who delivered at 22-42 weeks. BNP or NT-proBNP drawn within 90 days preceding delivery were identified and categorized as normal or elevated (BNP ≥ 100 or NT-proBNP ≥ 300 pg/mL). Patients were classified as having no heart disease (no HD), congenital heart disease (CHD), acquired (AHD), or both by ICD-10 code. The primary outcomes were SMM and non-transfusion SMM per CDC definitions. Heart disease, race/ethnicity, social vulnerability index, insurance, obesity, chronic renal disease, diabetes, and gestational diabetes were included as covariates in logistic regression models exploring the association between BNP testing and SMM.

Results:

1,817,361 pregnant individuals were included, of whom 1,679,306 (92.4%) had no HD, 13,648 (0.75%) CHD, 117,963 (6.49%) AHD, and 6,444 (0.35%) both. The groups differed with respect to all covariates (p< 0.001), including the proportion with a BNP within 90 days of delivery (no HD 4,685 (0.3%), CHD 131 (1.0%), AHD 2,030 (1.7%), and both 340 (5.3%); p< 0.001). Of those who experienced SMM (N=39,331), 38,652 (98.3%) had no BNP testing, 512 (1.3%) had normal BNP, and 167 (0.4%) had elevated BNP levels. The odds of SMM and non-transfusion SMM were higher in patients who had a BNP within 90 days of delivery even if it was normal (SMM aOR 2.5, 95% CI 2.3, 2.8; non-transfusion SMM aOR 3.4, 95% CI 3.1, 3.8), and higher still if BNP was elevated (SMM aOR 8.6, 95% CI 7.1, 10.3; non-transfusion SMM aOR 12.4, 95% CI 10.0, 15.3).

Conclusion:

Clinical judgment triggering BNP collection within 90 days of delivery likely identifies a cohort of patients at higher risk of SMM regardless of the result, but elevated results are associated with higher SMM risk.