Key result
AF during pregnancy and puerperium linked to ~100% higher in-hospital mortality.
Why the study?
Atrial fibrillation is a common cardiac arrhythmia, but data regarding its impact during delivery remain limited.
Does atrial fibrillation increase the risk of adverse cardiovascular outcomes and in-hospital mortality in pregnant and puerperal patients?
Observational (n=40,996,860)
Yes
Does atrial fibrillation increase the risk of adverse cardiovascular outcomes and in-hospital mortality in pregnant and puerperal patients?
Odds Ratio: 2.02 (95% CI 1.56–2.61)
Absolute Event Rate: 0.71% vs 0.01%
p-value: p=<0.001
Atrial fibrillation during pregnancy and puerperium is increasing in prevalence and is associated with significantly higher in-hospital mortality and adverse cardiovascular events, with risk scaling by CHA2DS2-VASc score.
Background Atrial fibrillation (AF) is a common cardiac arrhythmia, but data on the impact during delivery remains limited. Objectives The aim of the study is to examine a) the prevalence of AF during pregnancy and puerperium, b) the association between AF and adverse outcomes, and c) the association between adverse cardiovascular outcomes and CHA 2 DS 2 -VASc scores in patients with AF. Methods The National Inpatient Sample (NIS) database was used to identify pregnancy-related hospitalizations between 2008 and 2017. Adverse outcomes included: in-hospital mortality, stroke, acute heart failure, cardiogenic shock, acute kidney failure, and acute myocardial infarction. Logistic models were constructed to explore the relationship between AF and adverse outcomes. Results Of 40,996,860 pregnancy- and puerperium-related hospitalizations, 15,162 (0.037%) also had AF. The prevalence of AF increased from 2.18 (95%CI = 2.04–2.31) per 10,000 hospitalizations in 2008 to 4.87 (95%CI = 4.65–5.09) per 10,000 in 2017 ( P trend < 0.001). The proportion of patients with AF increased with advanced maternal age ( P trend < 0.001). The prevalence of AF was higher in Black individuals, those from low-income households, and those with advanced maternal age ( P trend < 0.001). Maternal patients with AF had significantly higher in-hospital mortality (OR = 2.02, 95%CI = 1.56–2.61, P < 0.001). Stroke, acute myocardial infarction, acute heart failure, and cardiogenic shock were associated with increasing CHA 2 DS 2 -VASc scores in patients with AF ( P trend < 0.001). Conclusions The prevalence of AF has been increasing in the pregnant and puerperium population and is associated with adverse outcomes. Higher CHA 2 DS 2 -VASc scores are associated with adverse outcomes in maternal patients with AF.
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Zeng et al. (2026) conducted an observational in Pregnancy and puerperium (n=40,996,860). Atrial fibrillation vs. No atrial fibrillation was evaluated on In-hospital mortality (OR 2.02, 95% CI 1.56-2.61, p=<0.001). Atrial fibrillation during pregnancy and puerperium was associated with a significantly higher risk of in-hospital mortality compared to hospitalizations without atrial fibrillation (OR 2.02).
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