Maternal and Fetal Outcomes Associated With Infective Endocarditis in Pregnancy

Abstract

Introduction Infective endocarditis (IE) is a rare but serious infection complicating pregnancy. Little is known about IE management and outcomes in this population. Methods The National Readmissions Database was used to obtain data between October 2015 and October 2018. Billing codes identified admissions for IE in female patients of reproductive age. Demographic characteristics, comorbidities, and outcomes were compared between a) patients with maternity-associated and non-maternity associated IE, and b) obstetric patients who delivered with and without IE. Weighted regressions were used to examine outcomes in adjusted models. Results We identified 12,602 reproductive-aged female patients with a diagnosis of IE, of which 382 (weighted national estimate: 748) were maternity-associated. Of these cases, 117 (weighted national estimate: 217) occurred during a delivery admission. Compared to patients with non-maternity-associated IE, maternity-associated infection was associated with younger age (mean 29.0 vs. 36.6 years, P < 0.001), Medicaid coverage (72.5% vs. 47.2%, P < 0.001), and drug use (76.2% vs. 59.8%, P < 0.001). Mortality was comparable (8.1% vs. 10.6%, aRR = 1.03, 95% CI 0.71–1.48). Compared to patients delivering without IE, IE complicating delivery was associated with worse maternal and fetal outcomes, including maternal mortality (17.2% vs. <0.01%, aRR = 323.32, 95% CI 127.74-818.37) and preterm birth (55.7% vs. 10.1%, aRR = 3.61, 95% CI 2.58–5.08). Conclusion Maternity-associated IE does not appear to confer additional risk for adverse outcome over non-maternity-associated infection. Patients delivering with IE have worse maternal and fetal outcomes than those whose deliveries are not complicated by IE.

Management of infective endocarditis in pregnancy by a multidisciplinary team: a case series

“…We also observed a high preterm delivery rate, with average gestational age at live birth of 32 weeks, similar to reported literature. 5 This led to further neonatal complications with half of the neonates requiring ICU admissions and prolonged lengths of stay. There were substantial rates of low fetal birth weight, low APGAR scores, respiratory distress syndrome, and intraventricular hemorrhage.…”

“… 3 In addition, more than half of deliveries complicated by endocarditis are pre-term with an average gestational age of 32.4 weeks, with further morbidity associated with prematurity. 5 While maternal outcomes from cardiac surgery are reportedly similar to non-pregnant women, current literature on management is limited to case series and retrospective reviews and data on neonatal outcomes have not been characterized. 3 , 6 , 7 Discussions regarding indications and timing of valve surgery are particularly complex given poor fetal outcomes with cardiopulmonary bypass.…”

Maternal risk factors vary between subpopulations of children with autism spectrum disorder

“…The DD/Seizures COCs cluster found Diseases of the Endocardium to be the highest non‐pregnancy risk factor, with an OR of 2.53 (1.39, 4.27). Diseases of the endocardium, such as endocarditis, have shown worse maternal and fetal outcomes (Dagher et al, 2021), however, little research has been done on their effect on ASD. The remaining non‐pregnancy related factors associated with the DD/Seizures COCs cluster are also factors for the ASD cohort overall (Grivas et al, 2021).…”

Infective endocarditis in pregnancy requiring simultaneous emergent caesarean section and mitral valve replacement: a case report

“… 1 Recent studies reported a maternal mortality rate for IE in pregnancy of 11%, 2 and in-hospital mortality rate during delivery of 17.2%. 3 The timing of and indications for surgical interventions for IE in pregnancy remain controversial. Foetuses with a gestational age (GA) <26 weeks are at a markedly higher risk of mortality and severe morbidities.…”