CVD a leading cause of pregnancy-related deaths in California

DALLAS — From 2002 to 2005, the leading cause of pregnancy-related deaths in California was heart disease, according to a report presented at AHA 2013.

The data were compiled using the California Pregnancy-Associated Mortality Review, which identifies and investigates maternal deaths, said Afshan B. Hameed, MD, FACC, FACOG. The maternity mortality rate in California increased from 5.6 per 100,000 live births in 1996 to 16.9 per 100,000 live births in 2006, according to data presented.

Early diagnosis important

“Early recognition and diagnosis is the key to better outcomes,” Hameed told Cardiology Today. “Education and awareness will help identify those at risk.”

Afshan B. Hameed

During the years studied, 2,147,492 live births occurred in California. Of those, 732 women died while pregnant or within 1 year of pregnancy; 209 deaths were pregnancy related. Fifty-one of the pregnancy-related deaths were from CVD, 35 of which were due to cardiomyopathy, Hameed said.

“Women with known CVD constitute less than one-quarter of the women who died, perhaps due to heightened awareness and appropriate referrals and treatment,” Hameed told Cardiology Today. “However, there were delays in diagnosis in pregnant and postpartum women.”

Compared with women who died of other causes, those who died from CVD were more likely to be black (39% vs. 17%; P<.01), have a BMI >30 (43% vs. 23%; P<.05), have documented substance abuse during pregnancy (28% vs. 9%; P<.01) and die 43 days or longer after giving birth (29% vs. 6%; P<.01). In 22% of the deaths attributed to CVD, there was a concomitant diagnosis of hypertension or preeclampsia. Similarly, women who died of cardiomyopathy were more likely to be African-American (43% vs. 17%; P<.01), have BMI >30 (49% vs. 23%; P<.01), have documented substance abuse during pregnancy (38% vs. 8%; P<.001) and to die 42 days or longer after giving birth (43% vs. 6%; P<.01), compared with women who died from other causes. In 29% of deaths attributed to cardiomyopathy, there was a concomitant diagnosis of hypertension or preeclampsia.

Twenty-nine women were diagnosed with CVD before they died. Among those women, mean time from symptom onset to diagnosis was 26 days and mean time from diagnosis to death was 79 days.

“Less than a quarter of women had their cardiovascular disease diagnosed before giving birth,” said Hameed, of the University of California, Irvine.

Some deaths preventable

The researchers also said that 35% of cardiomyopathy deaths and nearly 30% of all CVD-related deaths could have been prevented.

“Quality improvement opportunities for health care providers include better recognition of triggers such as shortness of breath, fatigue, altered mental status manifesting as anxiety, tachycardia, BP change or low oxygen saturation,” Hameed said. “Quality improvement opportunities for patients include education around when to seek care for worrisome symptoms and recognition of importance of continuing to take cardiac medications.”

Obstetricians should refer patients to cardiologists upon early recognition of a symptomatic patient, and medical care professionals should support efforts that help women maintain a healthy weight and avoid substance abuse, he said. – by Erik Swain

For more information:

Hameed AB. Abstract #18851. Presented at: the American Heart Association Scientific Sessions; Nov. 16-20, 2013; Dallas.

Disclosure: The researchers report no relevant financial disclosures.