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Heartbeat: cardiovascular maternal health and disparities in clinical outcomes
  1. Catherine M Otto
  1. Division of Cardiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Professor Catherine M Otto, Division of Cardiology, University of Washington, Seattle, WA 98195, USA; cmotto{at}

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Cardiovascular disease continues to account for a high proportion of pregnancy-related deaths in women in the USA. In addition to pre-existing heart disease, gestational hypertension and diabetes, as well as pre-eclampsia and eclampsia, are associated with an increased risk of adverse cardiovascular outcomes both in the short and long-term. In this issue of Heart, Marschner and colleagues1 report an incidence of cardiometabolic conditions (hypertensive disease and diabetes) of 224.3 (95% CI 221.3 to 227.3) per 1000 births among 74 510 women, mean age 26.4 years (SD 5.5) in a cross-sectional study of Medicare patients from 2015 to 19. The incidence of adverse cardiovascular outcomes (myocardial infarction, stroke, acute heart failure, cardiomyopathy, cardiac arrest, ventricular fibrillation, ventricular tachycardia, aortic dissection/aneurysm and peripheral vascular disease) was 10.8 (95% CI 10.1 to 11.6)per 1000 births. Overall the risk of a serious cardiovascular outcome was more than 3-fold higher in women with a pregnancy-related cardiometabolic condition, with the highest risk for patients with eclampsia or pre-eclampsia (figure 1).

Figure 1

ORs from final model of subsequent severe cardiovascular (CV) outcomes, age-adjusted and adjusted for each component of the pregnancy-related cardiometabolic conditions. DM, diabetes mellitus.

In the accompanying editorial, Ma, DeFaria Yeh and Schmidt2 point out that in 2017 maternal mortality per 100 000 live births was 17 in the USA compared with seven in the UK with prior …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.