Outcomes of Endocarditis in Pregnancy: A Single Center Experience

Abstract

Background: The incidence of infective endocarditis (IE) in pregnancy is rare (0.006%) with increasing prevalence during the opioid epidemic. IE in pregnancy is associated with high rates of maternal and fetal mortality and morbidity, and existing data on outcomes in pregnancy is limited to case reports and small studies. Our study compares the outcomes of pregnant patients with IE as compared to non-pregnant patients. Methods: Patients diagnosed with IE during pregnancy or 30 days post-partum between 2014-2021 were identified by ICD-9/10 codes. Pregnant cases were matched to a random sampling of non-pregnant reproductive-age female endocarditis patients in a 1:4 ratio. Demographic and clinical data was collected. Data was validated through chart review. Results: 180 patients with IE were identified for this cohort; 34 were pregnant or within 30 days post-partum at diagnosis. There were higher rates of hepatitis C and opioid maintenance therapy in the pregnant patients. Etiology of IE in pregnant patients was predominantly S. aureus (MSSA/MRSA) whereas non-pregnant woman had greater microbiological variation. We observed comparable rates of valve replacement (32.4% vs 29% p=0.84), 2-yr mortality (20.6% vs 17.8%, p =.>0.99), and ICU admission (61.8% vs 69.8%, p=0.414) in pregnant patients. There was a trend towards higher rates of PE (17.6% vs 7.5%, p=0.098), arrhythmia (17.6% vs 9.6%, p=0.222) among pregnant patients. There were high rates of IVDU relapse in both groups (>40%). Conclusion: We observed similar rates of valve replacement, 2-year mortality, and ICU admission in both pregnant and non-pregnant patients with IE. We observed a microbial predilection for S.aureus in pregnancy suggesting that the physiology of pregnancy may select for this microbiologic etiology. These results represent the largest single center retrospective review of IE in pregnancy and suggests that pregnancy may have increased morbidity.