Maternal and fetal outcomes were worse in women with infective endocarditis (IE) undergoing labor compared with women whose delivery were not complicated by IE, according to study results published in Clinical Infectious Diseases.

In this retrospective analysis, researchers used data from the National Readmissions Database from 28 states obtained between October 2015 and October 2018 to describe the effects of IE and pregnancy. The researchers compared clinical outcomes in 2 groups of reproductive-aged women: women with maternity-associated IE and those with non-maternity-associated IE, and women whose delivery was complicated by IE vs women whose delivery was not complicated by IE.

Of the 12,602 women with IE, 382 experienced maternity-associated IE, with a weighted national estimate of 748. There were 117 deliveries that were associated with IE, with a weighted national estimate of 217. Most maternity-associated IE occurred antepartum. In the same period, there were approximately 5 million admissions for delivery in women without IE.


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Compared with women with non-maternity-associated IE, women with maternity-associated IE were younger, more likely to be covered by Medicaid, and more likely to use drugs; they also had lower rates of general and cardiac comorbidities (P <.001 for all comparisons). However, in-hospital mortality rates were similar between the 2 groups (10.6% vs 8.1%; adjusted relative risk [aRR], 1.03; 95% CI, 0.71-1.48). In addition, length of hospital stay and inpatient costs were similar between the 2 groups (aRR, 1.07; 95% CI, 0.99-1.16 and aRR, 1.01; 95% CI, 0.91-1.12, respectively).

In women delivering with and without IE, IE significantly complicated delivery. Compared with women delivering without IE, women whose delivery was complicated by IE had higher rates of the following:

  • In-hospital mortality: 17.2% vs <0.1% (aRR, 323.32; 95% CI, 127.74-818.37)
  • Severe maternal morbidity: 77.5% vs 1.6% (aRR, 47.06; 95% CI, 38.10-58.14)
  • Cesarean delivery: 56.1% vs 32.2% (aRR, 2.04; 95% CI, 1.65-2.52)

Women with IE also had longer hospitalization stays (mean, 30.0 vs 2.7 days; aRR, 7.86; 95% CI, 6.57-9.41) and greater inpatient costs (mean, $72,400 vs $5,400; aRR, 10.98; 95% CI, 9.05-13.33).

Fetal outcomes were similarly worse in women with IE, and these outcomes included more stillbirths (4.4% vs 0.6%; aRR, 2.96, 95% CI, 1.21-7.24) and preterm deliveries (55.7% vs 10.1%; aRR, 3.61; 95% CI, 2.56-5.08).

An analysis using propensity score matching yielded similar results.

“Findings underscore that IE can have devastating effects on both mother and fetus when compared with outcomes of a typical maternity patient,” the researchers noted. “Further research is needed to fully describe this disease process and generate reliable data to guide the management and prevention in this unique population,” they concluded.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Dagher MM, Eichenberger EM, Addae-Konadu KL, et al. Maternal and fetal outcomes associated with infective endocarditis in pregnancy. Clin Infect Dis. Published online June 10, 2021. doi:10.1093/cid/ciab533