In 2011-2012, the three leading causes of maternal mortality in Texas were cardiac events, drug overdose, and hypertension/eclampsia, with two out of the three being cardiovascular-related conditions. While chronic conditions likely contribute to mortality, severe maternal morbidity (SMM) metrics only include eclampsia and do not include chronic cardiovascular conditions such as preexisting hypertension. To better understand the contribution of both pregnancy-induced and chronic cardiovascular conditions to SMM, the prevalence of comorbid cardiovascular conditions among women with SMM was assessed.METHODS:
Delivery-related hospitalizations between 2011-2014 were classified as SMM, based on the CDC’s coding scheme. Cardiovascular comorbidities among SMM were classified using the obstetric comorbidity coding scheme identified by Bateman et al (2013). Prevalence was assessed by age to examine whether older women with SMM had higher prevalence of these comorbidities.RESULTS:
SMM prevalence remained consistent between 2011 and 2014 (19.6-19.8 per 1,000 deliveries, p=0.57). Overall, SMM showed a quadratic relationship with age, with the youngest and oldest age groups having the highest prevalence (p<0.01). Among comorbidities assessed in SMM, the youngest and oldest age groups had the highest prevalence of severe preeclampsia/eclampsia. However, the prevalence of preexisting hypertension increased linearly with age.CONCLUSION:
Older women with SMM were comorbid for both pregnancy-induced and chronic cardiovascular conditions, whereas younger women had pregnancy-induced conditions. This finding suggests a need to assess the role of chronic cardiovascular conditions in SMM, especially among older women. Results also suggest that the narrowly defined SMM metric may underestimate the contribution of chronic cardiovascular conditions to severe maternal morbidity.