Pregnancy-Related Differences in Cardiogenic Shock: A National Analysis of Etiology, Risk Factors, and Outcomes.

Background: Cardiogenic shock is associated with high rates of mortality in pregnancy but remains understudied.

Objectives: We aim to understand the etiologies, risk factors, and outcomes of cardiogenic shock in women of childbearing age and identify whether there are pregnancy-related differences in procedural utilization.

Methods: We analyzed all delivery, pregnancy, and cardiogenic shock-related hospitalizations in reproductive-aged women (aged 18-45) using the National Inpatient Sample database (years 2016-2021).

Results: Pregnant women with vs without cardiogenic shock had higher rates of cardiovascular comorbidities and were more likely to have preeclampsia (21.3% vs 6.5%), placental hemorrhage (26.6% vs 4.3%), fetal death (10.0% vs 0.51%), and maternal death (17.8% vs 0.01%). Comparing pregnant vs nonpregnant women with cardiogenic shock, pregnant women had lower comorbidity burden and rates of multiorgan failure but higher rates of pulmonary edema (8.9% vs 4.7%). Pregnant women with cardiogenic shock were more likely to undergo extracorporeal membrane oxygenation (adjusted OR: 1.67 [95% CI: 1.07-2.65]) and less likely to die during admission (adjusted OR: 0.43 [95% CI: 0.28-0.66]). Nonpregnant women had higher frequencies of cardiogenic shock from ischemic cardiomyopathy (CM) (25.4% vs 12.4%) and congenital heart disease (5.6% vs 1.8%), while most pregnant women had cardiogenic shock related to nonischemic CM, specifically peripartum CM (30.8%).

Conclusions: There are differences in cardiogenic shock etiology, comorbidities, and clinical complications among pregnant vs nonpregnant women. Findings suggest that unique pregnancy-specific factors may contribute to cardiogenic shock in pregnancy.