Pregnant women who use substances such as cocaine, cannabis, or other drugs face significantly elevated risks of acute cardiovascular events while hospitalized for delivery, with maternal mortality rates more than doubling, according to a recent study.
The research, based on data from the National Inpatient Sample database spanning from 2004 to 2018, utilized diagnostic codes to identify instances of substance use among 955,531 pregnancies. The most frequently detected substances were cannabis and opioids, followed by stimulants. These cases were compared to over 60 million pregnancies where no substance use was reported.
The study’s primary focus was on any cardiovascular event, encompassing acute myocardial infarction, stroke, arrhythmia, endocarditis, acute cardiomyopathy or heart failure, or cardiac arrest. Additional outcomes examined included maternal mortality and major adverse cardiac events (MACE).
The data revealed a concerning trend, with deliveries complicated by substance use increasing from 1126 per 100,000 deliveries in 2004 to 1547 per 100,000 in 2018, reaching a peak of 2187 per 100,000 in 2014.
After adjusting for patient demographics and cardiovascular risk factors, the study demonstrated that pregnant women who used any substance (including cannabis, opioids, methamphetamine, alcohol, tobacco, or cocaine) had a significantly higher likelihood of experiencing a cardiovascular event (adjusted odds ratio [aOR], 1.61; 95% CI, 1.53 – 1.70; P < .001), MACE (aOR, 1.53; 95% CI, 1.46 – 1.61; P < .001), or maternal mortality (aOR, 2.65; 95% CI, 2.15 – 3.25; P < .001) during their hospitalization for delivery.
Notably, those using amphetamine/methamphetamine faced ninefold higher odds of developing cardiomyopathy or heart failure and over sevenfold higher odds of experiencing cardiac arrest.
The authors of the study underscored the urgent need to recognize substance use as an independent risk factor for cardiovascular events during pregnancy. They advocated for prenatal assessments conducted by multidisciplinary cardio-obstetrics teams as a means to mitigate cardiac complications.
In an accompanying editorial by Abha Khandelwal, MD, from the Department of Medicine at Stanford University, Palo Alto, California, the authors emphasized the crucial support required for substance-using individuals during pregnancy and the postpartum period. Comprehensive medical care, social services, access to addiction medicine, and treatment for co-occurring mental health disorders were highlighted as essential components of such support.
The study was conducted by Kari Evans, MD, from the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix. The findings were published online on September 18, 2023, in the Journal of the American College of Cardiology: Advances.
It’s important to note that the use of administrative databases may have led to underreporting of diagnoses. Additionally, the study did not assess the relationship between dose, duration, method, or timing of substance use and cardiovascular events. Differentiating between hospitalizations for delivery complicated by cardiovascular events and hospitalizations for cardiovascular events that triggered delivery was not possible. The data also did not cover the postpartum period, during which a high rate of adverse cardiovascular events occurs.
