Any substance use during pregnancy ups risk for acute heart events during delivery
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Key takeaways:
- Pregnant women reporting substance use during delivery hospitalization have elevated risk for CV events and death.
- Methamphetamine use was most strongly tied to adverse outcomes, but cannabis is not benign.
Use of any substance during pregnancy, including alcohol and cannabis but especially methamphetamines, is associated with increased risk for acute CV outcomes during delivery hospitalization, according to a nationwide database analysis.
In an analysis of more than 60 million delivery hospitalizations across the U.S., researchers also found that the risk was greatest for deliveries with documented amphetamine/methamphetamine use, with a ninefold increased risk for acute cardiomyopathy or HF and a sevenfold increased risk for acute MI and cardiac arrest.
“Already, a pregnant heart is under stress and we often say that pregnancy is nature’s cardiac stress test,” Martha Gulati, MD, MS, FACC, FAHA, FASPC, associate director of the Barbra Streisand Women’s Heart Center, director of preventive cardiology at the Smidt Heart Institute at Cedars-Sinai and president of the American Society for Preventive Cardiology, told Healio. “Then, you add something like methamphetamine use, which increases heart rate, BP and heart contractility. We also know methamphetamine use can induce vasospasm and cause electrical remodeling in the heart. This may explain why HF and MI are more likely in people who use those substances.”
Substance use and CV outcomes
Gulati and colleagues analyzed data from 60,014,368 women with a delivery hospitalization from 2004 to 2018, using the Nationwide Inpatient Sample, stratified on the presence or absence of substance use. The primary outcome was any acute CV event, defined as MI, stroke, arrhythmia, endocarditis, acute cardiomyopathy or HF, or cardiac arrest. Secondary outcomes were individual acute CV events, major adverse CV events and maternal mortality.
The findings were published in JACC: Advances.
Within the cohort, 1.6% of women reported substance use (n = 955,531).
Researchers found that overall substance use was independently associated with CV events (adjusted OR = 1.61; 95% CI, 1.53-1.7; P < .001), major adverse CV events (aOR = 1.53; 95% CI, 1.46-1.61; P < .001) and maternal mortality (aOR = 2.65; 95% CI, 2.15-3.25; P < .001) during delivery hospitalization.
All individual substances had an increased association with CV events; however, amphetamine/methamphetamine use had the strongest association, with a nearly threefold increased risk for CV events (aOR = 2.71; 95% CI, 2.35-3.12; P < .001). ORs for any CV event during delivery hospitalization were 1.8 for alcohol, 1.14 for cannabis, 1.45 for cocaine and 1.35 for opioids.
“These data parallel what we were seeing clinically,” Gulati said during an interview. “Data also showed that, of all substances, [methamphetamine] was associated with a ninefold greater risk for HF and a sevenfold greater risk for acute MI and cardiac arrest, along with an overall increase in the use of methamphetamine as well.”
Implications for public policy
Additionally, all substances other than cocaine and cannabis had a significant association with maternal death, Gulati said, who also cautioned that the legalization of cannabis in some states made analysis of that substance difficult.
“Cannabis use was not benign,” Gulati said. “It did not increase maternal mortality. Although cannabis use has lower rates in general of any CV events compared with other substances, people who used cannabis still had a twofold risk for acute MI. That is important for people to understand, especially as cannabis legalization has occurred in many states in our country. There should be further discussion with patients during family planning that these substances can be problematic during pregnancy and put women at risk, and we do not know the fetal effects.”
Gulati said much more research should be collected regarding substance use among pregnant women to allow better understanding about risks and outcomes, and to inform public health policy.
“The biggest barrier is there are limited data on substance use and its effect on cardiac events and mortality in pregnancy,” Gulati said. “For people caring for pregnant individuals with a history of substance use, that is a big problem in terms of knowing what to expect from an outcomes standpoint and to be better prepared for potential CV events.”
For more information:
Martha Gulati, MD, MS, FACC, FAHA, FASPC, can be reached at martha.gulati@cshs.org; X (Twitter): @drmarthagulati.
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