Substance abuse and pregnancy can form a perilous combination, as underscored by recent research findings. The study revealed that pregnant women with a history of substance abuse faced a significantly heightened risk of heart attack and stroke-related deaths during childbirth compared to their drug-free counterparts. Senior author Dr. Martha Gulati, who serves as the associate director of the Barbra Streisand Women’s Heart Center at the Smidt Heart Institute at Cedars-Sinai in Los Angeles, emphasized the critical implications of this research. She remarked, “This telling research shows that substance use during pregnancy doubled cardiovascular events and maternal mortality during delivery.” Additionally, Dr. Gulati noted that substance abuse also doubled the risk of acute heart failure.
The research encompassed an array of substances, including cocaine, opioids, alcohol, amphetamine/methamphetamine, and cannabis. Each substance was associated with different risks and complications.
Amphetamine and methamphetamine emerged as particularly concerning, with the highest association found with acute heart failure. These drugs were linked to a staggering nine-fold increase in the risk of acute heart failure, a 7.5-fold higher risk of acute heart attack, a seven-fold elevated risk of cardiac arrest, and a tripling of the risk of maternal death. Notably, amphetamines and methamphetamines are known to elevate heart rate and blood pressure, as well as induce structural and electrical changes in the heart.
Cocaine, on the other hand, exhibited the strongest association with stroke and was also linked to abnormal heart rhythms known as arrhythmias.
Opioid use had the most significant association with heart valve infections, specifically endocarditis. This risk arises because opioids are often injected directly into the bloodstream.
Alcohol use was predominantly associated with an increased risk of arrhythmias. Although cannabis was not associated with maternal death, it was linked to a doubled risk of heart attacks. Dr. Gulati highlighted that despite the widespread legalization of cannabis in various regions, many people remain unaware of the risks it poses during pregnancy. Cannabis use can result in heart cell damage and may lead to adverse cardiovascular events.
The study, which analyzed a nationwide database of over 60 million hospitalizations for deliveries spanning from 2004 to 2018, revealed that substance use complicated over 955,000 of those deliveries. Women in this group experienced a range of cardiovascular issues, including heart attacks, strokes, arrhythmias, endocarditis, acute cardiomyopathy, heart failure, and cardiac arrest.
Dr. Christine Albert, chair of cardiology at the Smidt Heart Institute, emphasized the need for enhanced medical care for pregnant women with substance use issues. She recommended that prenatal care for such women involve high-risk pregnancy specialists and cardiologists who can identify and minimize adverse outcomes. Dr. Albert concluded by stressing the importance of recognizing substance abuse as an independent risk factor for cardiovascular events during pregnancy. This research underscores the urgent need to address this issue for the well-being of pregnant women and their children.
These critical findings are published in the October issue of the Journal of the American College of Cardiology: Advances.
