According to the US Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report, approximately one-third of maternal mortality in the US was due to cardiovascular causes between 2011 and 2015. Researchers at Massachusetts General Hospital and Harvard Medical School sought to determine the burden of cardiovascular disease (CVD) during pregnancy over time, finding that both the prevalence of maternal CVD and the incidence of pregnancy-related cardiac complications increased between 2001 and 2019, and that those with more cardiac comorbidities during pregnancy were at increased risk for cardiac complications postpartum.
The study consisted of electronic health records compiled from multiple centres covering pregnancies between 2001 and 2019. A total of 56,833 pregnancies with 20 weeks’ gestation or more were recorded in 38,996 women between 18 and 59 over the course of the study. The researchers recorded the prevalence of pre-existing CVD, the incidence of cardiovascular complications during pregnancy, and cardiovascular comorbidities by race (Black/white/other) and age group (18 to 25, 26 to 35, 36 to 40 and 41 to 59).
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The prevalence of pre-existing maternal CVD in women aged 18 to 59 increased from 2.31% in 2001 to 5.83% in 2019, and the rate of CVD was higher in older age groups than younger age groups. Additionally, Black women had a higher burden of CVD (at 7.05%) than white women (6.22%) and women of other races (4.42%). Researchers found that this pattern repeated when measuring incident cardiovascular complications. There was an increase in complications in women of all ages (up from 13.37% in 2001 to 17.80% in 2019), older women were at higher risk (24.8%) than younger women (9.50%), and Black women had a higher incidence of complications (24.93%) than white women (17.9%) or women of other races (14.7%).
The study reported an increased risk of incident cardiovascular complications in the presence of pre-existing CVD (10% chance with versus 3% chance without) and comorbidities such as obesity (20% versus 11%), diabetes (6% versus 3%), hypertension (23% versus 5%) and hyperlipidemia (13% versus 10%). When measuring the burden of all of these comorbidities by age group and race, older women were found to have a higher prevalence than younger women. Black women had the highest prevalence of obesity, hypertension and diabetes.
GlobalData epidemiology data demonstrates a similar trend of comorbidities in women regardless of pregnancy. In the US in 2025, the diagnosed prevalence of obesity was 20% in women aged 18 to 19 and 33% in women aged between 55 and 59. The diagnosed prevalence of diabetes was <1% in women aged 15 to 19 and 10% in women aged 55 to 59. The pattern persists when investigating cardiovascular complications, as the diagnosed prevalence of myocardial infarction was 0.5% in women aged 25 to 29 and 4% in women aged 55 to 59 years, and the diagnosed prevalence of transient ischaemic attack was 0.5% in women aged 18 to 19 years and 4% in women ages 55 to 59.
Given the increased risk of cardiovascular complications in the presence of CVD and comorbidities, combined with the increased burden of both CVD and comorbidities in older women and Black women, the protection of pregnant women should therefore begin with comorbidity prevention efforts. Special attention should be paid to higher-risk demographics such as older women and racial minorities, especially Black women.
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By GlobalData
