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Rheumatoid Arthritis and CV Complications During Delivery
Quick Takes
- Pregnant women with rheumatoid arthritis (RA) had higher rates of CV complications at the time of delivery.
- Over the 15-year analysis, there was an increasing trend in cardiometabolic risk factors among pregnant women with RA.
Study Questions:
What is the association of rheumatoid arthritis (RA) with acute cardiovascular (CV) complications during delivery?
Methods:
The National Inpatient Sample (2004–2019) was utilized. International Classification of Diseases (ICD)-9 and ICD-10 codes were used to identify delivery hospitalizations, RA, other comorbidities, and outcomes. The primary endpoints were preeclampsia/eclampsia, peripartum cardiomyopathy, and acute heart failure. Secondary endpoints were stroke, pulmonary edema, cardiac arrhythmias, acute kidney injury, venous thromboembolism, length of stay, and cost of hospitalization. Other inflammatory arthropathies were excluded.
Results:
There were 11,979 delivery hospitalizations among persons with RA. Compared with those without RA, persons with RA were older and had higher prevalence of chronic hypertension, chronic diabetes, gestational diabetes mellitus, obesity, and dyslipidemia (p < 0.01). RA was associated with preeclampsia (adjusted odds ratio [aOR], 1.37; 95% confidence interval [CI], 1.27-1.47), peripartum cardiomyopathy (aOR, 2.10; 95% CI,1.11-3.99), arrhythmias (aOR, 2.00; 95% CI, 1.68-2.38), acute kidney injury (aOR, 1.79; 95% CI, 1.05-3.01), and venous thromboembolism (aOR, 1.90; 95% CI, 1.05-3.43) (adjusted for age, race/ethnicity, comorbidities, insurance, and income). From 2004–2019, there was an overall increasing trend of obesity, gestational diabetes mellitus, and acute CV complications among persons with RA.
Conclusions:
During delivery, RA was associated with higher risk of preeclampsia, peripartum cardiomyopathy, arrhythmias, acute kidney injury, and venous thromboembolism. Cardiometabolic risk factors increased over time among pregnant persons with RA.
Perspective:
RA is associated with higher risk of CV disease in the general population and is recognized as a nontraditional risk factor in primary prevention guidelines. During pregnancy, however, RA has not been well studied. This study of pregnant patients with RA demonstrated higher rates of acute CV complications at the time of delivery, including preeclampsia, arrhythmias, and peripartum cardiomyopathy. Whether chronic inflammation is the main driver of adverse pregnancy outcomes requires further study. Comorbidities may also play a role since the patients with RA were older and had higher rates of chronic hypertension, obesity, dyslipidemia, and gestational diabetes. Additionally, the prevalence of cardiometabolic risk factors among pregnant individuals with RA has increased over the past 15 years. As the field of cardio-obstetrics expands, increased awareness of nontraditional CV risk factors such as RA will be necessary for improved counseling and management of peripartum CV complications.
Clinical Topics: Prevention
Keywords: Arthritis, Rheumatoid, Cardiometabolic Risk Factors, Pregnancy, Cardio-Obstetrics
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