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Use of Assisted Reproductive Technologies, Diagnosis of SLE Linked to Increased CV Risk During Delivery Admissions

Data from a pair of studies presented at the American Heart Association 2022 Scientific Sessions are providing insight into the risk of cardiovascular complications during delivery admissions among different patient subgroups.

Leveraging data from the National Inpatient Sample (NIS), the studies detail the likelihood of various cardiovascular complications during delivery hospitalizations for those with systemic lupus erythematosus and those with a history of assisted reproductive technologies compared to their counterparts without such a history.

Cardiovascular Complications During Delivery in Systemic Lupus Erythematosus

From a search of NIS data recorded from 2004-2019, investigators identified 63,037,442 weighted delivery hospitalizations, with 77,560 involving women with systemic lupus erythematosus. Compared to their counterparts without systemic lupus erythematosus, those with systemic lupus erythematosus were older (median 30 [26-34] vs 28 [24-32] years; P <.01) and had a greater prevalence of comorbid conditions, including polycystic ovary syndrome (0.6% vs 0.3%), gestational diabetes mellitus (5.1% vs 3.9%), obesity (5.0% vs 4.0%), and dyslipidemia (0.5% vs 0.1%) (P for all <.01).

In analyses adjusted for age, race/ethnicity, comorbidities, insurance, and income, women with systemic lupus erythematosus were at increased likelihood of preeclampsia (aOR, 2.12 [95% CI, 2.07-2.17]), heart failure (aOR, 4.06 [95% CI, 3.61-4.57]), cardiac arrythmias (aOR, 2.06 [95% CI, 1.94-2.21]), acute kidney injury (aOR, 7.66 [95% CI, 7.06-8.32]), stroke (aOR, 4.83 [95% CI, 4.18-5.57]), pulmonary edema (aOR, 1.85 [95% CI, 1.52-2.25]), venous thromboembolism (aOR, 6.90 [95% CI, 6.11-7.80]), and peripartum cardiomyopathy (aOR, 4.42 [95% CI, 3.79-5.13]) (P for all <.01). When assessing resource utilization, results indicated those with systemic lupus erythematosus had longer length of stay (3 days vs 2 days; P <.01) and greater costs of hospitalization ($4953 vs $3722; P <.01) than their counterparts without systemic lupus erythematosus.

Cardiovascular Complications During Delivery in Women Using Assisted-Reproductive Technologies

Using NIS data from 2008-2019, investigators identified a total of 45,867,086 weighted delivery hospitalizations, with 108,542 including women using assisted reproductive technology. Compared to their counterparts without a history of using assisted reproductive technology, those with a history of using assisted reproductive technology were (median 35 [32-39] vs. 28 [24-32] years; P <.01) and had a greater prevalence of comorbid conditions, including hypertension (0.7% vs 0.5%), polycystic ovary syndrome (3.5% vs 0.4%), gestational diabetes mellitus (9.5% vs 4.4%), and dyslipidemia (0.5% vs 0.2%) (P for all <.01).

In analyses adjusted for age, race/ethnicity, comorbidities, insurance, and income, women with a history of assisted reproductive technologies were at an increased likelihood of preeclampsia (aOR, 1.48 [95% CI, 1.45-1.51]), heart failure (aOR, 1.94 [95% CI, 1.10-3.40]), cardiac arrhythmias (aOR, 1.39 [95% CI, 1.30-1.48]), acute kidney injury (aOR, 2.57 [95% CI, 2.25-2.92]), stroke (aOR, 1.57 [95% CI, 1.23-2.01]), pulmonary edema (aOR, 2.29 [95% CI, 2.02-2.61]), and venous thromboembolism (aOR, 1.92 [95% CI, 1.63-2.25]) (P for all <.01). When assessing resource utilization, results indicated those with a history of assisted reproductive technologies had a longer length of stay (3 days vs 2 days; P <.01) and greater costs of hospitalization ($5903 vs $3922; P <.01) than their counterparts without a history of assisted reproductive technologies.

Our editorial team sat down with study investigator Erin Michos, MD, associate professor of medicine at Johns Hopkins School of Medicine, at AHA 2022 to learn more about these studies and how they highlight the need to identify risk factors for cardiovascular complications to lower risk of negative outcomes in delivery admissions. That conversation is the subject of the video below.

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