Cardiovascular Complications Associated With COVID-19 During Delivery Hospitalizations in Pandemic Year 2020



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JACC: Advances


Background: Persons with COVID-19 infection have an increased risk of pregnancy-related complications. However, data on acute cardiovascular (CV) complications during delivery admissions remain limited.

Objectives: The purpose of this study was to determine whether pregnant individuals with COVID-19 have an increased risk of acute peripartum CV complications during their delivery admission.

Methods: This population-based retrospective cohort study used the 2020 National Inpatient Sample database. The International Classification of Diseases, 10th Revision codes were used to identify delivery admissions with a diagnosis of COVID-19. A multivariable logistic regression model was performed to determine the association between COVID-19 and acute peripartum CV complications at delivery.

Results: A total of 3,458,691 weighted delivery admissions were identified, of which 1.3% were among persons with COVID-19 (n = 46,375). Persons with COVID-19 were younger (median 28 vs 29 years, P < 0.01) and had a higher prevalence of gestational diabetes mellitus, preterm births, and Cesarean delivery (P < 0.01). After adjustment for age, race/ethnicity, comorbidities, insurance, and income, COVID-19 remained independently associated with peripartum CV complications including preeclampsia (adjusted odds ratio [aOR]: 1.33 [95% CI, 1.29-1.37]), peripartum cardiomyopathy (aOR: 2.09 [1.54-2.84]), acute coronary syndrome (aOR: 12.94 [8.85-18.90]), and arrhythmias (aOR: 1.55 [1.45-1.67]), compared with no COVID-19. Likewise, the risks of in-hospital mortality, acute kidney injury, stroke, pulmonary edema, and venous thromboembolism were higher with COVID-19. For resource utilization, the cost of hospitalization ($5,374 vs $4,837, P < 0.01) was higher for deliveries among persons with COVID-19.

Conclusions: In the year 2020, pregnant persons with COVID-19 had a higher risk of preeclampsia, in-hospital mortality, and other serious CV complication during delivery hospitalizations compared to pregnant individuals without COVID-19.

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