Rheumatoid arthritis and cardiovascular complications during delivery: a United States inpatient analysis

Background and Persons with rheumatoid arthritis (RA) have an increased risk of obstetric-associated complications, as well as long-term Aims cardiovascular (CV) risk. Hence, the aim was to evaluate the association of RA with acute CV complications during delivery admissions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Methods Data from the National Inpatient Sample (2004–2019) were queried utilizing ICD-9 or ICD-10 codes to identify delivery hospitalizations and a diagnosis of RA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Results A total of 12 789 722 delivery hospitalizations were identified, of which 0.1% were among persons with RA (n = 11 979). Individuals with RA, vs. those without, were older (median 31 vs. 28 years, P < .01) and had a higher prevalence of chronic hypertension, chronic diabetes, gestational diabetes mellitus, obesity, and dyslipidaemia (P < .01). After adjustment for age, race/ethnicity, comorbidities, insurance, and income, RA remained an independent risk factor for peripartum CV complications including preeclampsia [adjusted odds ratio (aOR) 1.37 (95% confidence interval 1.27–1.47)], peripartum cardiomyopathy [aOR 2.10 (1.11–3.99)], and arrhythmias [aOR 2.00 (1.68–2.38)] compared with no RA. Likewise, the risk of acute kidney injury and venous thromboembolism was higher with RA. An overall increasing trend of obesity, gestational diabetes mellitus, and acute CV complications was also observed among individuals with RA from 2004–2019. For resource utilization, length of stay and cost of hospitalization were higher for deliveries among persons with RA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusions Pregnant persons with RA had higher risk of preeclampsia, peripartum cardiomyopathy, arrhythmias, acute kidney injury, and venous thromboembolism during delivery hospitalizations. Furthermore, cardiometabolic risk factors among pregnant individuals with RA rose over this 15-year period. Structured Graphical Abstract Key Question Are pregnant women with rheumatoid arthritis (RA) at higher risk of acute cardiovascular complications at the time of admission for delivery? Key Finding In a 15-year analysis of 12 million delivery admissions from 2004-2019 in the U.S., women with RA had elevated peripartum cardiovascular complications. The study also noted a rising trend in cardiometabolic risk factors among pregnant women with RA. Take Home Message RA is an independent risk factor for peripartum cardiovascular complications. This study underscores the importance of optimizing and addressing cardiometabolic health before, during, and after pregnancy. Acute peripartum cardiovascular complications with rheumatoid arthritis NIS (2004−2019) 12 789 722 Baseline characteristics With RA ^Age Without RA 11 979 (0.1%) ^{31 (27-35)}_[p<.01]^vs. 28 ^(24-32) 12 777 743 (99.9%) Chronic hypertension 1.5% vs. 0.7% [p<.01] Obesity 6.8% vs. 4.0% [p<.01] Dyslipidaemia 0.7% vs. 0.1% [p<.01] GDM 5.9% vs. 3.8% [p<.01] Adjusted analysis (age, race/ethnicity, comorbidities, Trend analysis insurance, and income) Adjusted odds ratio Preeclampsia 1.37 (1.27-1.47) p<.01 Increase in prevalence of RA _Heart failure 2.05 (0.68-6.16) p=0.26 among delivery admissions _Cardiac arrhythmias 2.00 (1.68-2.38) p<.01 Acute kidney injury 1.79 (1.05-3.01) p=0.03 Increase in prevalence ^Stroke 1.01 (0.42-2.44) p=0.98 of cardiometabolic ^Pulmonary oedema 1.33 (0.66-2.66) p=0.43 risk factors in pregnancy ^Venous thromboembolism 1.90 (1.05-3.43) p=0.03 Peripartum cardiomyopathy 2.10 (1.11-3.99) p<.01 Increase in acute peripartum _utilization Resource cardiovascular complication _{Length of stay 3} days vs 2 days p<.01 rates with RA _Cost of hospitalization $4377 vs $3718 p<.01 Acute peripartum cardiovascular complications with rheumatoid arthritis.