ABSTRACT
BACKGROUND
Cardiovascular diseases, including acute coronary syndromes, are the leading cause
of maternal death in many developed countries.
OBJECTIVE
We assessed acute coronary syndrome incidences during pregnancy, peripartum, and postpartum
periods. We also compared overall pregnancy (ie, covering all 3 periods) incidence
with that found in nonpregnant women of childbearing age.
STUDY DESIGN
All women aged between 15 and 49 years without ischemic heart disease who delivered
between 2010 and 2018 in France were included in the CONCEPTION cohort. Data were
extracted from the French National Health Insurance Information System database. Acute
coronary syndromes were defined according to the International Classification of Diseases,
Tenth Revision codes recorded in the principal hospital diagnosis. We used Poisson
regression to estimate crude acute coronary syndrome incidences, and tested age-adjusted
Poisson models to compare the incidence risk ratio of acute coronary syndrome between
pregnant and nonpregnant women, with 95% confidence intervals.
RESULTS
Among 6,298,967 deliveries in France, we observed 225 first-time acute coronary syndrome
diagnoses during overall pregnancy (overall pregnancy-related acute coronary syndrome
incidence, 4.34/100,000 person-years; 1 case/23,000 pregnancies). In multivariate
analysis, independent factors associated with acute coronary syndrome were age, social
deprivation, obesity, tobacco use, chronic hypertension, and hypertensive disorders
of pregnancy (all P<.05). Among the nonpregnant women aged 15 to 49 years in the general French population,
18,247 cases of acute coronary syndrome (incidence, 16.5/100,000 person-years) occurred
throughout the whole study period (>100 million person-years). Compared with the acute
coronary syndrome incidence in nonpregnant women, age-adjusted overall pregnancy-related
acute coronary syndrome incidence was lower (incidence rate ratio, 0.76; 95% confidence
interval, 0.57-0.98; P<.05). Although compared with nonpregnant women, age-adjusted incidence rates were
lower during pregnancy, risk was increased during peripartum and postpartum periods.
CONCLUSION
With an incidence of 4.34 per 100,000 person-years, acute coronary syndrome still
accounts for a significant proportion of maternal mortality. The peripartum and postpartum
periods remain high-risk periods, and greater efforts should be made in terms of acute
coronary syndrome prevention, especially because several cardiovascular risk factors
are treatable, such as tobacco use and hypertensive disorders of pregnancy.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & Gynecology MFMAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Centers for Disease Control and Prevention. Pregnancy mortality surveillance system. Available at: http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PMSS.html. 2022. Accessed July 5, 2022.
- Maternal mortality in France 2013-2015: an evolving profile.Gynecol Obstet Fertil Senol. 2021; 49: 1-2
United Nations Population Fund. Estimates by WHO, UNICEF, and UNFPA, World Bank Group and the United Nations Population Division. 2019. Available at: https://www.unfpa.org/featured-publication/trends-maternal-mortality-2000-2017. Accessed July 5, 2022.
- Acute myocardial infarction associated with pregnancy.J Am Coll Cardiol. 2008; 52: 171-180
- Increased risks of circulatory diseases in late pregnancy and puerperium.Epidemiology. 2001; 12: 456-460
- Development of a comorbidity index for use in obstetric patients.Obstet Gynecol. 2013; 122: 957-965
- Myocardial infarction in pregnancy and postpartum in the UK.Eur J Prev Cardiol. 2013; 20: 12-20
- Cardiovascular physiology of pregnancy.Circulation. 2014; 130: 1003-1008
- Incidence of first stroke in pregnant and nonpregnant women of childbearing age: a population-based cohort study from England.J Am Heart Assoc. 2017; 6e004601
- Acute myocardial infarction in pregnancy: a United States population-based study.Circulation. 2006; 113: 1564-1571
- Value of a national administrative database to guide public decisions: from the Systeme National d'Information Interregimes de l'Assurance Maladie (SNIIRAM) to the Systeme National des Donnees de Sante (SNDS) in France.Rev Epidemiol Sante Publique. 2017; 65: S149-S167
- Prevalence of hypertensive disorders during pregnancy in France (2010-2018): the Nationwide CONCEPTION study.J Clin Hypertens (Greenwich). 2021; 23: 1344-1353
- Hypertensive disorders of pregnancy and onset of chronic hypertension in France: the nationwide CONCEPTION study.Eur Heart J. 2022; 43: 3352-3361
- 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).Eur Heart J. 2018; 39: 119-177
- 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.Eur Heart J. 2021; 42: 1289-1367
- Incidence of myocardial infarction in pregnancy: a systematic review and meta-analysis of population-based studies.Eur Heart J Qual Care Clin Outcomes. 2017; 3: 198-207
- Incidence of stroke and myocardial infarction in women of reproductive age.Stroke. 1997; 28: 280-283
- Pregnancy: a stress test for life.Curr Opin Obstet Gynecol. 2003; 15: 465-471
- Risk of miscarriage in women with chronic diseases in Norway: a registry linkage study.PLoS Med. 2021; 18e1003603
- Évolution NR de la consommation de tabac à l'occasion d'une grossesse en France en 2016.Boll Epidémiol Hebd. 2018; 35-36 (Available at): 694-703
- Acute stroke during pregnancy and puerperium.J Am Coll Cardiol. 2020; 75: 180-190
- Ischemic heart disease in pregnancy.Semin Perinatol. 2014; 38: 304-308
- Risk factors and timing of acute myocardial infarction associated with pregnancy: insights from the National Inpatient Sample.J Am Heart Assoc. 2020; 9e016623
- Acute myocardial infarction during pregnancy and the puerperium in the United States.Mayo Clin Proc. 2018; 93: 1404-1414
- 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy.Eur Heart J. 2018; 39: 3165-3241
- Evaluation of the metrological quality of the medico-administrative data for perinatal indicators: a pilot study in 3 university hospitals.Rev Epidemiol Sante Publique. 2015; 63: 237-246
Article info
Publication history
Published online: October 19, 2022
Accepted:
October 17,
2022
Received:
October 1,
2022
Footnotes
J.B. reports, outside the submitted work, personal fees from Abbott Laboratories, Bayer, Laboratoires Bottu, Egis, Ferring Pharmaceuticals, Steripharma, Kantar Group, Sanofi, Servier Laboratories, and Teriak Laboratories and nonfinancial support from Pfizer and Quantum Genomics. S.K. reports, outside the submitted work, nonfinancial support from Lilly France, Novo Nordisk, Novartis, Roche Diabetes Care, LifeScan, Abbott France, Sanofi, ViiV Healthcare, Servier Laboratories, and Becton Dickinson and Company, and personal fees from Icomed, Pascaleo, B3TSI, and M3 Global Research. The other authors report no conflict of interest.
Cite this article as: Blacher J, Lailler G, Gabet A, et al. Acute coronary syndrome during pregnancy and postpartum in France: the nationwide CONCEPTION study. Am J Obstet Gynecol MFM 2022;XX:x.ex-x.ex.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
