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Time Trends in the Prevalence, Severe Morbidity, and Utilization of Resources in Pulmonary Hypertension During Pregnancy.
Abstract Number: S2A-5
Abstract Type: Original Research
Pulmonary hypertension (PH) during pregnancy carries a poor maternal prognosis and poses specific challenges for obstetric anesthesiologists. Prevalence of pregnant women with secondary PH may be increasing because more women with heart diseases reach childbearing age(1). Relatively small case series from major academic centers suggest that outcomes of PH during pregnancy may have improved(2-4). This study examined the time trends in the prevalence, severe morbidity, and utilization of resources of PH during pregnancy.
PH, pregnancy, morbidity, and resources were identified using ICD-9-CM codes in the 2003-2014 New York State Inpatient Database. New York State ranks 3rd for the number of childbirths. PH was categorized as primary or secondary. Outcomes included: 1) spontaneous pregnancy loss, 2) medical termination of pregnancy, 3) continuation of pregnancy until delivery, and 4) post-delivery hospitalization. Definition of morbidity was adapted from the U.S. C.D.C. and included 18 conditions. Resources utilization included 7 resources. Conditions and resources had to be associated with in-hospital death or hospital length-of-stay > 90th percentile. Cochran-Armitage trend tests were used to assess changes in prevalence and outcomes over time.
2,969,686 discharges indicating pregnancy were identified. PH was recorded in 947 cases or 32 per 100,000 (95% confidence interval (CI), 30-34). It was secondary in 868 (92%). Pregnancy proceeded until delivery in 669 cases (71%), which was via cesarean delivery in 415 (62%) under general anesthesia in 20% of cases. Between 2003 and 2014, prevalence of primary PH decreased 76% (P < 0.001) while secondary PH increased 86% (P < 0.001). Pregnancies proceeding until delivery increased 65% (P <0. 001) while spontaneous losses or medical terminations of pregnancy were unchanged. PH was associated with substantially increased risk of morbidity (adjusted odds ratio (aOR) 9.4; 95% CI, 7.6-11.6) and utilization of resources (aOR 7.2; 95% CI, 5.8-8.9). The 2 most common complications were respiratory failure (prevalence 8.3%) and heart failure (5.5%); the 2 most utilized resources were blood transfusion (prevalence 12.7%) and mechanical ventilation (7.2%). No change in morbidity and utilization of resources was observed between 2003 and 2014.
The prevalence of secondary PH during pregnancy and of pregnancies with PH that proceeded until delivery has markedly increased in New York State since 2003. PH remains a major risk factor for severe maternal morbidity and utilization of resources. The 9-fold increase in severe morbidity emphasizes the need for screening of women with PH before conception or early during pregnancy to inform on the risks associated with an ongoing pregnancy.
1.Obstet Gynecol 2015;126:346-542.
2.Eur Heart J 2009;30:256-65.