Contemporary Burden of Cardiovascular Disease in Pregnancy: Insights from a Real-World Pregnancy Electronic Health Record Cohort
Authors: Lau Emily S. , D’Souza Valentina , Zhao Yunong , Reeder Christopher , Goldberg Rachel , Economy Katherine E. , Maddah Mahnaz , Khurshid Shaan , Ellinor Patrick T. , Ho Jennifer E. 
Published: January 2025

ABSTRACTImportanceCardiovascular disease (CVD) is the leading cause of maternal morbidity and mortality, however the contemporary burden and secular trends in pregnancy-related CV complications are not well characterized.ObjectiveWe sought to examine contemporary trends in prevalence of maternal cardiometabolic comorbidities and established CVD, as well as future pregnancy-related CV complications across a large multi-institutional health system.DesignRetrospective analysis of longitudinal electronic health record (EHR)-based cohort of pregnanciesSettingMulti-institutional healthcare network in New EnglandParticipantsPregnancy encounters between 2001 to 2019 identified using diagnosis and procedure codes followed by manual adjudication within a previously validated primary care EHR cohort. Estimated gestational ages recovered from unstructured notes using regular expressions (RegEx) were used to define individual pregnancy episodes.Main Outcomes and MeasuresWe quantified the prevalence of maternal cardiometabolic comorbidities and established CVD at time of pregnancy, as well as the incidence of pregnancy-related CV complications assessed within 1 year postpartum. We examined trends in cardiometabolic risk factors and CVD burden over nearly two decades.ResultsOur EHR pregnancy cohort comprised 57,683 pregnancies among 38,997 individuals (mean age range at start of pregnancy 27 to 37 years). RegEx recovered gestational age for 74% of pregnancies, with good correlation between gestational age ascertained via RegEx vs manual review (Pearson r 0.9). Overall prevalence of maternal CVD was 4% (age-adjusted 7%) and increased over 19 years of follow-up (age-adjusted prevalence of maternal CVD: 1% in 2001 to 7% in 2019, p <0.001). The incidence of pregnancy-related CV complications was 15% (age-adjusted 17%) and also increased over the follow-up period (age-adjusted incidence 11% in 2001 to 14% in 2019, p <0.001). Finally, CV complications were more likely to occur in individuals with greater burden of maternal CV comorbidities and CVD (diabetes: 6% vs 3%, hypertension: 23% vs 5%, pre-existing CVD: 10% vs 3%, P<0.001 for all).Conclusions and RelevanceAnalysis of a large-scale EHR-based pregnancy cohort spanning two decades demonstrates rising prevalence of both maternal cardiometabolic comorbidities and CVD at the time of pregnancy, as well as increasing incidence of subsequent pregnancy-related CV complications. Pregnancy represents a critical opportunity for cardiometabolic health optimization.KEY POINTSQuestionWhat are the contemporary real-world trends in the prevalence of maternal cardiovascular comorbidities and cardiovascular disease and incidence of cardiovascular complications in pregnancy?FindingsIn an analysis of 57,683 pregnancies among 38,997 individuals from a large scale EHR-based pregnancy cohort, prevalence of maternal cardiometabolic comorbidities and cardiovascular disease and incidence of pregnancy-related cardiovascular complications increased over the course of nearly two decades.MeaningThe contemporary burden of pregnancy-related cardiovascular complications is rising at an alarming rate and highlights pregnancy as a critical opportunity for cardiovascular health optimization.