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

Abstract

Background and aims: Persons with rheumatoid arthritis (RA) have an increased risk of obstetric-associated complications, as well as long-term 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.

Keywords: Cardiovascular disease; Gestational diabetes mellitus; Preeclampsia; Pregnancy; Rheumatoid arthritis.

Structured Graphical Abstract

Acute peripartum cardiovascular complications with rheumatoid arthritis. RA, rheumatoid arthritis; PCOS, polycystic ovary syndrome; GDM, gestational diabetes mellitus; RA, rheumatoid arthritis; NIS, National Inpatient Sample

Figure 1

Study flow chart. NIS, National Inpatient Sample; RA, rheumatoid arthritis; PCOS, polycystic ovary syndrome; GDM, gestational diabetes mellitus; APC, annual percentage change; CI, confidence interval. Estimated are based on the non-weighted sample

Figure 2

Trends of prevalence of rheumatoid arthritis of during delivery hospitalizations (2004–2019). The graph illustrates a rise in the prevalence of rheumatoid arthritis during delivery hospitalizations in the USA between the years of 2004 and 2019. Estimates are based on the non-weighted sample

Figure 3

Trends of prevalence of polycystic ovary syndrome, gestational diabetes, and obesity among individuals with rheumatoid arthritis during delivery hospitalizations. The graph illustrates a rise in the prevalence of cardiometabolic risk factors during delivery hospitalizations among rheumatoid arthritis patients in the USA between the years 2004 and 2019. Effect sizes are presented as an annual percentage rise in prevalence from 2004 to 2019 with 95% confidence intervals. US, United States; PCOS, polycystic ovary syndrome; GDM, gestational diabetes mellitus; RA, rheumatoid arthritis; APC, annual percentage change; CI, confidence interval

Figure 4

Trend of prevalence of acute peripartum cardiovascular complications among patients with rheumatoid arthritis. The graph illustrates a rise in the prevalence of acute cardiovascular complications during delivery hospitalizations among patients with rheumatoid arthritis in the USA between the years 2004 and 2019. Effect size is presented as an annual percentage rise in prevalence from 2004 to 2019 with 95% confidence intervals. Estimates are based on the non-weighted sample

Figure 5

Unadjusted and adjusted odds ratio for in-hospital complications for persons with rheumatic arthritis (RA) compared to those without RA during delivery admission. Estimated are based on the non-weighted sample

Figure 6

Relationship between age and acute peripartum cardiovascular complications among patients with rheumatoid arthritis. One-year increase in age above 35, there was a percentage increase of ∼13.9% in the odds of experiencing an acute cardiovascular complication among patients with rheumatoid arthritis (P < .01). Results are based on the non-weighted sample