Skip to main content
SMFM 2024 Pregnancy Meeting Main banner
Final Program


Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared on social media
Faculty have requested this content not be shared on social media
CME Credit Offered
CME Credit Offered
Poster Icons
Foundation Awardee
Foundation Awardee
No Social Media
No Social Media
Back
Q&A

Epidemiology

Poster Session 3

(735) Mode of delivery does not impact cardiovascular morbidity in patients with prior cardiovascular disease

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
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) affects up to 44% of women aged 20 years or older, making it an increasingly prevalent problem in persons of reproductive age. Patients with pre-existing CVD who become pregnant face an increased risk of adverse maternal and fetal outcomes. There is limited evidence available to guide the mode of delivery in persons with a history of CVD. The objective of this study is to determine if the mode of delivery affects CVD-related morbidity in a person with prior CVD. We hypothesize that patients with pre-existing CVD who undergo a cesarean delivery will be at increased risk of CVD morbidity in the first year after delivery.

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 pre-existing CVD and who experience CVD morbidity within the calendar year of index delivery. Associations between mode of delivery and CVD morbidity were determined from Cox proportional hazards regression models before and after adjusting for potential confounders including hospital bed size, teaching status, patient insurance, and income.

Results: Of the 19,217 patients with prior CVD who underwent delivery, 46% (n = 8,914) underwent a cesarean. Rates of CVD hospitalizations per 100,000 delivery discharges were 9,748 and 9,607 for cesarean and vaginal delivery (adjusted hazard ratio [HR] 0.98, 95% confidence interval [CI] 0.77, 1.11) (Table). The risk for stroke was highest in the first 30 days after the index delivery (adjusted HR 1.81, 95% CI 0.87-3.74) and diminished with increasing latency.

Conclusion: In patients with pre-existing CVD, the mode of delivery was not associated with the risk of CVD-related morbidity in the year following delivery. These findings support the recommendations that the usual obstetrical indications should be used to guide the mode of delivery in persons with pre-existing CVD.