Abstract Body (Do not enter title and authors here): BACKGROUND: Atrial fibrillation (AF) during pregnancy and puerperium is devastating for the mother and her family, yet data regarding incidence and outcomes are very limited.
OBJECTIVE: We aimed to investigate the incidence and outcomes of AF during pregnancy and puerperium in a large database. The value of the CHA₂DS₂-VASc score in predicting adverse outcomes during pregnancy was also assessed.
STUDY DESIGN: The National Inpatient Sample (NIS) database was queried to identify pregnancy-related hospitalizations from 2008 to 2017. Temporal trends in the incidence and outcomes of AF were extracted. The CHA₂DS₂-VASc score was calculated for all patients, and the score was classified into three groups: low-risk group (1 point), moderate-risk group (2-3 points), and high-risk group (≥4 points).
RESULTS: Among 40,996,860 pregnancy-related hospitalizations, 15,162 (0.037%) were diagnosed with AF. The incidence increased from 2.18 per 10,000 hospitalizations in 2008 to 4.87 per 10,000 in 2017 (P_trend < .0001). The proportion of patients with AF increased with advanced maternal age (P_trend < .0001). Subgroup analysis showed that the incidence of AF was higher in black women, lowest-income households, and elderly parturients (P_trend < .0001). The following factors were significantly associated with AF during pregnancy: age ≥45 years, lipid metabolism disorders, hypertension, obstructive sleep apnea, hyperthyroidism, and valvular disease (P < .0001). The in-hospital mortality rate of pregnant women with AF was significantly higher than those without AF (OR = 2.26, 95%CI = 1.75-2.93, P < .0001). The mortality rate of AF during pregnancy was positively associated with an increasing CHA₂DS₂-VASc score (P_trend < .0001), which was 0.35% (95% CI: 0.24%-0.47%) in the low-risk group, 1.30% (95% CI: 0.98%-1.62%) in the moderate-risk group, and 2.18% (95% CI: 0.86%-3.51%) in the high-risk group. The incidence of stroke, acute myocardial infarction, acute heart failure, and cardiac shock during pregnancy was also significantly correlated with the increasing CHA₂DS₂-VASc score in AF patients (P_trend < .0001), with the highest prevalence in the high-risk group.
CONCLUSION: The incidence of AF during pregnancy and puerperium increased consistently, associated with high maternal mortality. The CHA₂DS₂-VASc score can be an essential risk stratification tool to predict severe cardio-cerebral vascular events and even death in AF patients during pregnancy and puerperium.