Pregnancy CVD risk calculator may underestimate odds for events among low-resource women
Click Here to Manage Email Alerts
Key takeaways:
- A cohort of predominantly Hispanic women receiving Medicaid may be at higher CV risk during pregnancy than a risk calculator predicts.
- There were also high neonatal ICU admission rates after delivery.
ATLANTA — Pregnant women with fewer economic resources may still be at elevated risk for CVD despite a low score on a CVD risk calculator, researchers reported.
The CARPREG II risk index was created to better predict prognosis during pregnancies with heart disease, as 15% to 30% of CV complications can result in mortality, Kimberly R. Ding, MD, a resident physician at Harbor-UCLA Medical Center, said during a moderated poster presentation at the American College of Cardiology Scientific Session.
“There is a paucity of data and cardio-obstetrics is still a developing area, so we sought to ask: Does the CAPREG II index score underestimate maternal risk in low socioeconomic status women?” Ding said during the presentation.
In a retrospective study, researchers analyzed data from 69 women seen from 2019 to 2023 at two Los Angeles County safety-net hospitals. The mean age of women was 29 years and 81% identified as Hispanic; all received Medicaid. Most patients had obesity and many reported prior or concurrent substance abuse, Ding said.
The primary outcomes were CV and obstetric complications at 1 to 6 months postpartum, maternal readmissions, and neonatal ICU (NICU) admission. The researchers compared the predicted vs. observed CARPREG II scores, categorized by 0 to 1, 2, 3, 4 and more than 4, with higher scores associated with increased risk for maternal CV events. The CARPREG risk score consists of 10 predictors, with an increasing number of predictors corresponding to increasing risk for maternal CV complications during pregnancy. For example, prior CV events or arrhythmias or systemic ventricular dysfunction are 3 points each; pulmonary hypertension or CAD are 2 points each; and no prior CV intervention is 1 point.
Within the cohort, approximately 30% of women had a CARPREG II score of 0 to 1; fewer than 5% of patients had a CARPREG II score of 2.
Ding said 41% of women had congenital heart disease, 22% had cardiomyopathy and 15% had arrhythmias. Additionally, 34% of women experienced CV events during pregnancy and 47% of women experienced obstetric complications, including gestational diabetes, preeclampsia and eclampsia.
Researchers observed low maternal readmission rates after delivery overall; however, 41% of neonates required NICU admission.
“You might be curious about 41% of women having congenital heart disease and 41% neonate NICU admission — we did go back and look at those data, and it was not one-to-one,” Ding said. “Not everyone who had congenital heart disease had a neonate in the NICU.”
When applying the CARPREG II index, there were no significant differences in observed vs. predicted CV outcomes (P = .79). However, the researchers observed higher event rates than expected for women with CARPREG index scores of 2. Women with a CARPREG score of 2 had a 10% risk for CV events, according to the calculator, yet 50% of these women experienced CV complications. Predicted vs. observed events were more balanced across other scores.
Ding said the study is ongoing and more data are needed to better understand any underlying mechanisms that might explain the findings.
“Our data does suggest that women of low socioeconomic status with CARPREG scores of 2 have notably higher event rates than expected,” Ding said. “Although CV event rates were low, high NICU admission really does suggest that low socioeconomic status has an impact on neonatal outcomes in women with CVD.”
Collapse
Ding KR, et al. Abstract 1021-09. Presented at: American College of Cardiology Scientific Session; April 6-8, 2024; Atlanta.
Click Here to Manage Email Alerts