Substance Use in Pregnancy Linked to Adverse CVD Outcomes

Pauline Anderson

September 25, 2023


Women who use cocaine, cannabis, or other substances during pregnancy have increased risks of acute cardiovascular (CV) events while in the hospital for delivery, including more than double the risk of maternal mortality, a new study shows.


  • Using the National Inpatient Sample database to identify hospital deliveries between 2004 and 2018 and diagnostic codes to identify maternal substance use, researchers compared 955,531 pregnancies with accompanying substance use ― the most common substances being cannabis and opioids, followed by stimulants ― to over 60 million pregnancies in which there was no substance use.

  • The primary outcome was any CV event, including acute myocardial infarction, stroke, arrhythmia, endocarditis, any acute cardiomyopathy or heart failure, or cardiac arrest; other outcomes included maternal mortality and major adverse cardiac events (MACE).


  • Deliveries complicated by substance use increased from 1126 per 100,000 deliveries in 2004 to 1547 per 100,000 in 2018, peaking at 2187 per 100,000 in 2014.

  • After controlling for patient demographics and CVD risk factors, results showed that pregnant women who used any substance (cannabis, opioids, methamphetamine, alcohol, tobacco, or cocaine) were more likely to experience a CVD event (adjusted odds ratio [aOR], 1.61; 95% CI, 1.53 – 1.70; P < .001), MACE (aOR, 1.53; 95% CI, 1.46 – 1.61; P < .001), or maternal mortality (aOR, 2.65; 95% CI, 2.15 – 3.25; P < .001) during hospitalization for delivery.

  • Those using amphetamine/methamphetamine had ninefold higher odds of cardiomyopathy or heart failure and more than sevenfold higher odds of cardiac arrest.


"For the wellbeing of pregnant women and their children, substance use needs to be considered an independent risk factor for CV events in pregnancy," the authors write. They call for prenatal assessments by a multidisciplinary cardio-obstetrics team to try to decrease cardiac complications.

In an accompanying editorial by Abha Khandelwal, MD, Department of Medicine, Stanford University, Palo Alto, California, and others, the authors said the findings "highlight the critical support required during pregnancy and postpartum" for substance users, which should include comprehensive medical care and social services as well as access to addiction medicine and treatment of co-occurring mental health disorders.


The study was carried out by Kari Evans, MD, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix. It was published online September 18, 2023, in the Journal of the American College of Cardiology: Advances.


Use of administrative databases may have resulted in underreporting of diagnoses. The researchers could not assess the association of dose, duration, method, or timing of use for any substance with CV events. They also could not examine the effect of vaping on maternal CV events or differentiate hospitalizations for delivery that were complicated by CV events from hospitalizations for CV events that prompted delivery. The data did not reflect the postpartum period, during which a high rate of adverse CV events occurs.


The authors and editorial writers have no relevant conflicts of interest.

For more news, follow Medscape on Facebook, X, Instagram, and YouTube.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.