Racial Disparities in Cardiovascular Outcomes for Pregnant and Postpartum Women

By Lisa Rapaport

January 11, 2021

(Reuters Health) - Black pregnant and postpartum women have higher rates of cardiovascular morbidity and mortality than their white or Hispanic counterparts, a U.S. study suggests.

Researchers examined data on 46,700,637 pregnancy-related hospitalizations identified in the Nationwide Inpatient Sample from 2007 to 2017. Overall, 46.3% of the patients were white, 13.5% were Black, and 19.1% were Hispanic.

Compared to white women, Black women had the highest mortality (adjusted odds ratio 1.45), as well as higher likelihood of myocardial infarction (aOR 1.23), stroke (aOR 1.57), pulmonary embolism (aOR 1.42), and peripartum cardiomyopathy (aOR 1.71).

Hispanic women also had higher mortality (aOR 1.23) and stroke (aOR 1.23) than white women, but Hispanic women had a lower chance of pulmonary embolism (aOR 0.66) and peripartum cardiomyopathy (aOR 0.69), according to the report published in the Journal of the American Heart Association.

The study also found disparities for Pacific Islander/Asian women, who had a higher risk of mortality (aOR 2.00), stroke (aOR 1.08), and peripartum cardiomyopathy (aOR 1.11) than white women, but a lower risk of acute myocardial infarction (aOR 0.77) and pulmonary embolism (aOR 0.34).

"Physicians and clinicians should be judicious about women at high risk of cardiovascular disease and should understand that the rate of events is low, yet, the women who suffer from cardiovascular events have serious consequences including debility and death," said senior study author Dr. Samir Kapadia, chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic in Ohio.

"The ability to identify the women at high risk and monitoring them will help clinicians prevent serious events or lessen the consequences of those events to improve the overall health and well-being of pregnant women in the U.S.," Dr. Kapadia said by email.

The incidence of in-hospital mortality did decrease for Black women during the study period, falling from 38.1 to 21.9 per 100,000 hospitalizations, and the stroke rate also declined from 85.5 to 54.2 per 100,000 hospitalizations.

However, the rates of acute myocardial infarction climbed from 24.2 to 36.4 per 100,000 hospitalizations, while pulmonary embolism rates rose from 29.3 to 60.7 per 100,000 and rates of peripartum cardiomyopathy increased from 236.4 to 296.2 per 100,000.

The absolute risk of morbidity and mortality was low. In-hospital mortality, for example, was around 0.01% in white, Hispanic and Asian/Pacific Islander women and about 0.03% for Black women.

Among women with comorbidities such as diabetes mellitus or a history of cardiovascular disease, Black women had higher rates of morbidity and mortality than white women, the study also found.

Limitations of the study include the reliance on ICD codes to identify morbidity and mortality, and these records lack details on disease severity and may allow coding errors to influence the results, the researchers note. They also lacked certain demographic information such as patient education level and household size and data on multiple pregnancies or multiple hospitalizations.

Black and Hispanic women are at increased risk for traditional cardiovascular risk factors such as diabetes mellitus, hypertension, and obesity, noted Dr. Evelina Grayver, director of the Women's Heart Program at Katz Women's Institute at Northwell Health's Sandra Atlas Bass Heart Hospital in Manhasset, New York.

"It is essential that clinicians understand the various communities, including nuances in disease presentation, risk factors, lifestyle management including nutritional components, and treatment among different racial and ethnic groups," Dr. Grayver, who wasn't involved in the study, said by email.

"Awareness of these communities' attributes, as well as differences in incidence, risk factor burdens, prognosis and treatment are necessary to mitigate racial and ethnic disparities in pregnant women who are at risk for cardiovascular disease," Dr. Grayver added.

SOURCE: https://bit.ly/2LfCh0l Journal of the American Heart Association, online December 16, 2020.