Maternal and Fetal Outcomes Associated With Infective Endocarditis in Pregnancy. (10th June 2021)

• Record Type: Journal Article
• Authors: Dagher, Michael M; Eichenberger, Emily M; Addae-Konadu, Kateena L; Dotters-Katz, Sarah K; Kohler, Celia L; Fowler, Vance G; Federspiel, Jerome J
• Is Part Of: Clinical infectious diseases. Volume 73:Number 9(2021)
• Page Start: 1571
• Page End: 1579
• Publication Date: 2021-06-10
• Subjects: infective endocarditis -- pregnancy -- delivery; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciab533
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Infective endocarditis (IE) is a rare but serious infection that complicates 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 patients with maternity-associated and nonmaternity-associated IE and 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 with patients with nonmaternity-associated IE, maternity-associated infection was associated with younger age (mean, 29.0 vs 36.6 years; P < .001), Medicaid coverage (72.5% vs 47.2%; P < .001), and drug use (76.2% vs 59.8%; P < .001). Mortality was comparable (8.1% vs 10.6%; adjusted rate ratio [aRR], 1.03; 95% confidence interval [CI]: .71–1.48). Compared with patients who delivered 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). Conclusions: Maternity-associated IE does not appear to confer additional risk for adverse outcome over nonmaternity-associated infection. Patients who deliver with IE have worse maternal and fetal outcomes than those whose deliveries are not complicated by IE. Abstract : Infective endocarditis (IE) during pregnancy is rare. Using a large cohort, we found that maternity-associated IE does not confer additional risk over nonmaternity-associated infection. However, IE during an admission for delivery was associated with poor maternal and fetal delivery outcomes.