{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T12:51:32Z","timestamp":1768567892167,"version":"3.49.0"},"posted":{"date-parts":[[2025,1,29]]},"group-title":"Cardiovascular Medicine","reference-count":31,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,1,29]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Importance<\/jats:title>\n                  <jats:p>Cardiovascular disease (CVD) is the leading cause of maternal morbidity and mortality, however the contemporary burden and secular trends in pregnancy-related CV complications are not well characterized.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>We sought to examine contemporary trends in prevalence of maternal cardiometabolic comorbidities and established CVD, as well as future pregnancy-related CV complications across a large multi-institutional health system.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Retrospective analysis of longitudinal electronic health record (EHR)-based cohort of pregnancies<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Multi-institutional healthcare network in New England<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Pregnancy encounters between 2001 to 2019 identified using diagnosis and procedure codes followed by manual adjudication within a previously validated primary care EHR cohort. Estimated gestational ages recovered from unstructured notes using regular expressions (RegEx) were used to define individual pregnancy episodes.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Main Outcomes and Measures<\/jats:title>\n                  <jats:p>We quantified the prevalence of maternal cardiometabolic comorbidities and established CVD at time of pregnancy, as well as the incidence of pregnancy-related CV complications assessed within 1 year postpartum. We examined trends in cardiometabolic risk factors and CVD burden over nearly two decades.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Our EHR pregnancy cohort comprised 57,683 pregnancies among 38,997 individuals (mean age range at start of pregnancy 27 to 37 years). RegEx recovered gestational age for 74% of pregnancies, with good correlation between gestational age ascertained via RegEx vs manual review (Pearson r 0.9). Overall prevalence of maternal CVD was 4% (age-adjusted 7%) and increased over 19 years of follow-up (age-adjusted prevalence of maternal CVD: 1% in 2001 to 7% in 2019, p &lt;0.001). The incidence of pregnancy-related CV complications was 15% (age-adjusted 17%) and also increased over the follow-up period (age-adjusted incidence 11% in 2001 to 14% in 2019, p &lt;0.001). Finally, CV complications were more likely to occur in individuals with greater burden of maternal CV comorbidities and CVD (diabetes: 6% vs 3%, hypertension: 23% vs 5%, pre-existing CVD: 10% vs 3%, P&lt;0.001 for all).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions and Relevance<\/jats:title>\n                  <jats:p>Analysis of a large-scale EHR-based pregnancy cohort spanning two decades demonstrates rising prevalence of both maternal cardiometabolic comorbidities and CVD at the time of pregnancy, as well as increasing incidence of subsequent pregnancy-related CV complications. Pregnancy represents a critical opportunity for cardiometabolic health optimization.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>KEY POINTS<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Question<\/jats:title>\n                    <jats:p>What are the contemporary real-world trends in the prevalence of maternal cardiovascular comorbidities and cardiovascular disease and incidence of cardiovascular complications in pregnancy?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>In an analysis of 57,683 pregnancies among 38,997 individuals from a large scale EHR-based pregnancy cohort, prevalence of maternal cardiometabolic comorbidities and cardiovascular disease and incidence of pregnancy-related cardiovascular complications increased over the course of nearly two decades.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Meaning<\/jats:title>\n                    <jats:p>The contemporary burden of pregnancy-related cardiovascular complications is rising at an alarming rate and highlights pregnancy as a critical opportunity for cardiovascular health optimization.<\/jats:p>\n                  <\/jats:sec>\n                <\/jats:sec>","DOI":"10.1101\/2025.01.28.25320930","type":"posted-content","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T18:00:20Z","timestamp":1738173620000},"source":"Crossref","is-referenced-by-count":0,"title":["Contemporary Burden of Cardiovascular Disease in Pregnancy: Insights from a Real-World Pregnancy Electronic Health Record Cohort"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9361-6397","authenticated-orcid":false,"given":"Emily S.","family":"Lau","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"D\u2019Souza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunong","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Reeder","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Goldberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine E.","family":"Economy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahnaz","family":"Maddah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaan","family":"Khurshid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick T.","family":"Ellinor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer E.","family":"Ho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2025013102400516000_2025.01.28.25320930v1.1","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0000000000000349"},{"key":"2025013102400516000_2025.01.28.25320930v1.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.9043"},{"key":"2025013102400516000_2025.01.28.25320930v1.3","unstructured":"Maternal Mortality Rates in the United States, 2021. March 16, 2023. Accessed July 22, 2024. https:\/\/www.cdc.gov\/nchs\/data\/hestat\/maternal-mortality\/2021\/maternal-mortality-rates-2021.htm"},{"key":"2025013102400516000_2025.01.28.25320930v1.4","doi-asserted-by":"publisher","DOI":"10.26099\/ta1q-mw24"},{"key":"2025013102400516000_2025.01.28.25320930v1.5","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001000"},{"key":"2025013102400516000_2025.01.28.25320930v1.6","unstructured":"CDC. Pregnancy Mortality Surveillance System. Maternal Mortality Prevention. May 20, 2024. Accessed October 28, 2024. https:\/\/www.cdc.gov\/maternal-mortality\/php\/pregnancy-mortality-surveillance\/index.html"},{"key":"2025013102400516000_2025.01.28.25320930v1.7","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002114"},{"key":"2025013102400516000_2025.01.28.25320930v1.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.02.076"},{"key":"2025013102400516000_2025.01.28.25320930v1.9","doi-asserted-by":"publisher","DOI":"10.1161\/hc3001.093437"},{"key":"2025013102400516000_2025.01.28.25320930v1.10","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz136"},{"key":"2025013102400516000_2025.01.28.25320930v1.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.01.039"},{"key":"2025013102400516000_2025.01.28.25320930v1.12","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.501"},{"key":"2025013102400516000_2025.01.28.25320930v1.13","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2019-314702"},{"key":"2025013102400516000_2025.01.28.25320930v1.14","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4794"},{"key":"2025013102400516000_2025.01.28.25320930v1.15","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-022-00590-0"},{"key":"2025013102400516000_2025.01.28.25320930v1.16","unstructured":"CDC. Pregnancy-Related Deaths: Data From Maternal Mortality Review Committees in 36 U.S. States, 2017\u20132019. Maternal Mortality Prevention. May 30, 2024. Accessed November 8, 2024. https:\/\/www.cdc.gov\/maternal-mortality\/php\/data-research\/mmrc-2017-2019.html"},{"key":"2025013102400516000_2025.01.28.25320930v1.17","doi-asserted-by":"publisher","DOI":"10.1037\/e584012012-001"},{"key":"2025013102400516000_2025.01.28.25320930v1.18","unstructured":"Welcome to Python.org. Python.org. July 18, 2024. Accessed July 22, 2024. https:\/\/www.python.org\/"},{"key":"2025013102400516000_2025.01.28.25320930v1.19","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac669"},{"key":"2025013102400516000_2025.01.28.25320930v1.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.05.048"},{"key":"2025013102400516000_2025.01.28.25320930v1.21","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvu012"},{"key":"2025013102400516000_2025.01.28.25320930v1.22","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004824"},{"key":"2025013102400516000_2025.01.28.25320930v1.23","doi-asserted-by":"crossref","unstructured":"Ogden CL , Carroll MD , Fryar CD , Flegal KM . Prevalence of Obesity Among Adults and Youth: United States, 2011-2014. NCHS Data Brief. 2015;(219):1\u20138.","DOI":"10.1001\/jama.2014.732"},{"key":"2025013102400516000_2025.01.28.25320930v1.24","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181c4ee8c"},{"key":"2025013102400516000_2025.01.28.25320930v1.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2024.101095"},{"key":"2025013102400516000_2025.01.28.25320930v1.26","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-016-1025-6"},{"key":"2025013102400516000_2025.01.28.25320930v1.27","doi-asserted-by":"publisher","DOI":"10.1111\/cts.12178"},{"key":"2025013102400516000_2025.01.28.25320930v1.28","doi-asserted-by":"publisher","DOI":"10.13063\/2327-9214.1203"},{"key":"2025013102400516000_2025.01.28.25320930v1.29","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3284"},{"key":"2025013102400516000_2025.01.28.25320930v1.30","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S269400"},{"key":"2025013102400516000_2025.01.28.25320930v1.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2015.10.031"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1101\/2025.01.28.25320930","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T20:26:34Z","timestamp":1768508794000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.1101\/2025.01.28.25320930"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,29]]},"references-count":31,"URL":"https:\/\/doi.org\/10.1101\/2025.01.28.25320930","relation":{},"subject":[],"published":{"date-parts":[[2025,1,29]]},"subtype":"preprint"}}