Severe Maternal Morbidity According to Mode of Delivery Among Pregnant Patients With Cardiomyopathies.

Background: Women with cardiomyopathies are at risk for pregnancy complications. The optimal mode of delivery in these patients is guided by expert opinion and limited small studies.
Objectives: The objective of this study is to examine the association of delivery mode with severe maternal morbidity events during delivery hospitalization and readmissions among patients with cardiomyopathies.
Methods: The Premier inpatient administrative database was used to conduct a retrospective cohort study of pregnant patients with a diagnosis of a cardiomyopathy. Utilizing a target trial emulation strategy, the primary analysis compared outcomes among patients exposed to intended vaginal delivery vs intended cesarean delivery (intention to treat). A secondary analysis compared outcomes among patients who delivered vaginally vs by cesarean (as-treated). Outcomes examined were nontransfusion severe maternal morbidity during the delivery hospitalization, blood transfusion, and readmission.
Results: The cohort consisted of 2,921 deliveries. In the primary analysis (intention to treat), there was no difference in nontransfusion morbidity (adjusted OR [aOR]: 1.17; 95% CI: 0.91-1.51), blood transfusion (aOR: 1.27; 95% CI: 0.81-1.98), or readmission (aOR: 1.03; 95% CI: 0.73-1.44) between intended vaginal delivery and intended cesarean delivery. In the as-treated analysis, cesarean delivery was associated with a 2-fold higher risk of nontransfusion morbidity (aOR: 2.44; 95% CI: 1.85-3.22) and blood transfusion (aOR: 2.26; 95% CI: 1.34-3.81) when compared with vaginal delivery.
Conclusions: In patients with cardiomyopathies, a trial of labor does not confer a higher risk of maternal morbidity, blood transfusion, or readmission compared with planned cesarean delivery.
Competing Interests: Funding Support and Author Disclosures Dr Meng has received grant support from the Foundation for Anesthesia Education and Research. Dr Federspiel has received support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development under award K12HD103083 during the study period; and has served as a consultant for Hemosquid, SA. Dr Engelhard is supported by grant 1K01MH127309 from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)