Pregnancy-specific factors contribute to the development and complications of cardiogenic shock, as well as outcomes, a new national analysis proposes. Oluwalonimi N. Adebowale, MD, of the Johns Hopkins Bayview Medical Center, Baltimore, and Anushka V. Desai, BS, of the Georgetown University School of Medicine, Washington, DC, and colleagues, reported these findings in a manuscript published Wednesday online in JACC: Advances. Cardiovascular disease remains a leading cause of death and mortality among pregnant women in the U.S. Cardiogenic shock significantly contributes to increased death rates during pregnancy. Investigators in this analysis examined the etiologies, risk factors and outcomes of cardiogenic shock in women who were between the ages of 18 and 45 (defining childbearing age for this study). The National Inpatient Sample database was used for data collection between 2016-2021. Women were classified into 3 groups: pregnant and hospitalized without cardiogenic shock, pregnant and hospitalized with cardiogenic shock and not pregnant but hospitalized with cardiogenic shock. A total of 22,705,692 women who were pregnant were hospitalized without cardiogenic shock during the time frame, and 845 were hospitalized with cardiogenic shock (mean age=30.7 years; 51.8% white, 22.2% Black, 17.3% Hispanic). For comparison, 31,932 women who had hospitalizations without pregnancy but with cardiogenic shock were included (mean age=35.4 years; 51.5% white, 28.7% Black, 11.1% Hispanic). In terms of causes, nonpregnant women had higher rates of cardiogenic shock from ischemic cardiomyopathy (25.4% vs 12.4%, p<0.001) and congenital heart disease (5.6% vs 1.8%). Peripartum cardiomyopathy was the most common cause of cardiogenic shock in pregnant women (30.8%). Pregnant women with cardiogenic shock, compared with pregnant and no cardiogenic shock, had higher rates of preeclampsia (21.3% vs 6.5%), placental hemorrhage (26.6% vs 4.3%), preterm delivery (10.0% vs 5.0%), fetal death (10.0% vs 0.51%) and maternal death (17.8% vs 0.01%). Pregnant women who had cardiogenic shock had lower rates of comorbidity burdens, multiorgan failure and deaths during admission (adjusted odds ratio [OR]=0.43, 95% confidence interval [CI]=0.26-0.66) compared with nonpregnant women with cardiogenic shock, but pregnant women had higher rates of pulmonary edema (8.9% vs 4.7%, p=0.013) and extracorporeal membrane oxygenation (adjusted OR=1.67, 95% CI=1.07-2.65). Comorbidities like hypertension, diabetes, dyslipidemia, chronic kidney disease, obesity and chronic heart failure, were all more common in nonpregnant women with cardiogenic shock compared with pregnant women. Overall, several factors contribute to development of cardiogenic shock in pregnant women and corresponding comorbidities, and additional factors contribute to higher mortality rates. “These findings underscore the importance of optimizing patients’ cardiovascular risk profiles prior to pregnancy and the need for close monitoring of high-risk patients during pregnancy to screen for developing cardiovascular complications,” the authors wrote. Source: Adebowale ON, Desai AV, Rahman F, et al. Pregnancy-related differences in cardiogenic shock: A national analysis of etiology, risk factors, and outcomes. JACC Adv. 2025 July 23 (Article in press). Image Credit: nenetus – stock.adobe.com