Published Online
on March 13, 2006

A more recent version of this article appeared on March 28, 2006

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Submitted on July 18, 2005
Revised on December 17, 2005
Accepted on January 27, 2006

Acute Myocardial Infarction in Pregnancy. A United States Population-Based Study

Andra H. James MD, MPH^*, Margaret G. Jamison PhD, Mimi S. Biswas MD, MHS, Leo R. Brancazio MD, Geeta K. Swamy MD, MHS, and Evan R. Myers MD, MPH

From the Divisions of Maternal-Fetal Medicine (A.H.J., L.R.B., G.K.S.) and Epidemiology (M.G.J., E.R.M.), Department of Obstetrics and Gynecology, and the Division of Cardiology, Department of Medicine (M.S.B.), Duke University Medical Center, Durham, NC.

^* To whom correspondence should be addressed. E-mail: andra.james{at}duke.edu.

Background--The purpose of this study was to determine the incidence, mortality, and risk factors for pregnancy-related acute myocardial infarction in the United States.

Methods and Results--The Nationwide Inpatient Sample for the years 2000 to 2002 was queried for all pregnancy-related discharges. A total of 859 discharges included a diagnosis of acute myocardial infarction, for a rate of 6.2 (95% confidence interval [CI] 3.0 to 9.4) per 100 000 deliveries. Among these, there were 44 deaths, for a case fatality rate of 5.1%. The odds of acute myocardial infarction were 30-fold higher for women aged 40 years and older than for women <20 years of age. Single independent variables that were statistically and clinically significant, including age, race, and certain medical conditions and obstetric complications, were entered into a multivariable logistic regression model. Hypertension (odds ratio [OR] 21.7, 95% CI 6.8 to 69.1), thrombophilia (OR 25.6, 95% CI 9.2 to 71.2), diabetes mellitus (OR 3.6, 95% CI 1.5 to 8.3), smoking (OR 8.4, 95% CI 5.4 to 12.9), transfusion (OR 5.1, 95% CI 2.0 to 12.7), postpartum infection (OR 3.2, 95% CI 1.2 to 10.1), and age 30 years and older remained as significant risk factors for pregnancy-related acute myocardial infarction. Black race was eliminated as a risk factor in the multivariable analysis, which suggests that the increased incidence among black women is explained by an increased prevalence of other cardiovascular risk factors.

Conclusions--Although acute myocardial infarction is a rare event in women of reproductive age, pregnancy increases the risk 3- to 4-fold. Certain medical conditions and complications of pregnancy increase the risk further and are potentially modifiable risk factors.

Key words: epidemiology • mortality • myocardial infarction • pregnancy • risk factors

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