• Posted September 21, 2023

Substance Abuse Greatly Raises Odds of Heart Attack, Stroke During Pregnancy

Substance abuse and pregnancy may be a dangerous combination.

New research finds that pregnant women with a history of substance abuse had a dramatically increased risk of death from heart attack and stroke during childbirth compared to women with no drug history.

“This telling research shows that substance use during pregnancy doubled cardiovascular events and maternal mortality during delivery,” said senior author Dr. Martha Gulati, associate director of the Barbra Streisand Women's Heart Center at the Smidt Heart Institute at Cedars-Sinai in Los Angeles.

“Substance abuse also doubled the risk of acute heart failure," she said in an institute news release.

Researchers studied a variety of substances, including cocaine, opioids, alcohol, amphetamine/methamphetamine and cannabis. Each posed different risks.

Amphetamine/methamphetamine had the greatest association with acute heart failure. These drugs were linked with a nine-times higher risk for acute heart failure; 7.5-times greater risk of acute heart attack; a seven-times higher risk of cardiac arrest, and triple the risk of maternal death.

Amphetamines and methamphetamine are known to increase heart rate and blood pressure and cause structural and electrical changes of the heart.

Cocaine had the strongest association with stroke. It was also associated with arrhythmias, which are abnormal heart rhythms.

Opioid use had the strongest association with infection of the heart valves, called endocarditis. These drugs are often injected into the bloodstream.

Alcohol use was associated with the greatest risk for arrhythmias.

While cannabis was not associated with maternal death, it was associated with double the risk of heart attack.

“Despite the widespread legalization of cannabis across the nation, many people are unfamiliar with the risks it can pose during pregnancy,” Gulati said. “Cannabis causes heart cell death and can also lead to severe cardiovascular events.”

Data for the study came from a nationwide database of more than 60 million hospitalizations for deliveries from 2004 to 2018. Substance use complicated more than 955,000 of those deliveries, with women experiencing heart attack, stroke, arrhythmia, endocarditis, acute cardiomyopathy, heart failure and cardiac arrest, the study found.

“This study highlights the need for additional medical care for pregnant women with substance use,” said Dr. Christine Albert, chair of cardiology at the Smidt Heart Institute.

Prenatal care for women with a history of substance use should include high-risk pregnancy specialists and cardiologists who could help identify and minimize adverse outcomes, she said.

“For the well-being of pregnant women and their children, substance abuse needs to be considered an independent risk factor for cardiovascular events in pregnancy,” Albert said in the release.

Study findings appear in the October issue of the Journal of the American College of Cardiology: Advances.

More information

The U.S. National Institutes of Health has more on heart health and pregnancy.

SOURCE: Cedars-Sinai, news release, Sept. 18, 2023