708 - Infective Endocarditis Complicating Delivery in Pregnancy: Risk Factors, Complications, and Delivery Outcomes

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Presenting Author(s)

Michael M. Dagher

Research Scholar
Duke University Medical Center
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

Emily Eichenberger

Infectious Disease Fellow
Duke University
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KA

Kateena L. Addae-Konadu

Maternal Fetal Medicine Clinical Fellow
Duke University Medical Center
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SD

Sarah K. Dotters-Katz

Assistant Professor of Obstetrics and Gynecology
Duke University Medical Center
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Vance G. Fowler

Professor of Medicine
Duke University Medical Center
Durham, NC
Disclosure: Achaogen (Consultant)Actavis (Grant/Research Support)Advanced Liquid Logics (Grant/Research Support)Affinergy (Consultant, Research Grant or Support)Affinium (Consultant)Allergan (Grant/Research Support)Ampliphi Biosciences (Consultant)Basilea (Consultant, Research Grant or Support)Bayer (Consultant)C3J (Consultant)Cerexa (Consultant, Research Grant or Support)Contrafect (Consultant, Research Grant or Support)Cubist (Grant/Research Support)Debiopharm (Consultant)Destiny (Consultant)Durata (Consultant)Forest (Grant/Research Support)Genentech (Consultant, Research Grant or Support)Integrated Biotherapeutics (Consultant)Janssen (Consultant, Research Grant or Support)Karius (Grant/Research Support)Locus (Grant/Research Support)Medical Biosurfaces (Grant/Research Support)Medicines Co. (Consultant)Medimmune (Consultant, Research Grant or Support)Merck (Consultant, Research Grant or Support)NIH (Grant/Research Support)Novadigm (Consultant)Novartis (Consultant, Research Grant or Support)Pfizer (Grant/Research Support)Regeneron (Consultant, Research Grant or Support)Tetraphase (Consultant)Theravance (Consultant, Research Grant or Support)Trius (Consultant)xBiotech (Consultant)
JF

Jerome Federspiel

Maternal Fetal Medicine Fellow in Training
Duke University Medical Center
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Infective endocarditis (IE) is a rare but serious complication of pregnancy. Its impact on delivery outcomes is unknown. In this study, we use a national administrative database to compare outcomes of deliveries complicated by IE to non-IE deliveries.

Methods: The National Readmissions Database was used to identify discharges between Oct. 2015 and Dec. 2017 for deliveries in patients aged 12 – 55 years with concomitant IE, which were compared to those deliveries without IE. Demographics, comorbidities, and outcomes were obtained. Differences between groups were analyzed using weighted Chi-squared test for categorical variables and weighted linear regression for continuous variables. Weighted multivariate regression models adjusted for demographic, facility, and comorbidity conditions were used to evaluate the association between IE and delivery outcomes.

Results: We identified 88 individuals with IE complicating their delivery hospitalization, corresponding to a national estimate of 162 admissions during the study period, who were compared to 4,401,879 delivery hospitalizations not complicated by IE (weighted national estimate 8,375,536). Patients with IE were more likely to reside in ZIP codes with median incomes in the lowest national quartile (46.3% vs. 28.1%, P = 0.003) and were more likely to be insured by Medicaid (76.5% vs. 42.1%, P < 0.001). Rates of pre-existing cardiac valve disease (39.9% vs. 0.2%, P < 0.001) and congenital heart disease (6.6% vs 0.1%, P < 0.001) were higher in those with IE, as well as drug abuse (69.3% vs. 2.6%, P < 0.001). Unadjusted analyses demonstrated higher rates of in-hospital mortality for IE-associated admissions (12.1% versus 0.005%), along with high rates of severe maternal morbidity, stillbirth, preterm birth, and cesarean birth, and longer lengths of stay and total hospital costs. These differences persisted despite adjustment using multivariate methods (Table).Clinical and Resource Utilization Outcomes

Conclusion: The presence of IE during an admission for delivery is associated with poorer outcomes for both pregnant patients and their fetuses. The occurrence of IE during pregnancy was associated with lower income, a history of cardiac disease, and drug abuse.