Abstract 12105: Sudden Death Associated With Pregnancy

Introduction: Sudden and unexpected deaths associated with pregnancy are rare but devastating occurrences in society. There is a significant lack of prospective, population-based data in the US regarding etiologies and clinical manifestation. Hypothesis: Prospective community-wide analyses can inform the assessment of burden as well as prevention strategies for sudden deaths associated with pregnancy. Methods: From the ongoing prospective, Oregon Sudden Unexpected Death Study (ORSUDS, Portland OR catchment pop. 1 M, 2002-2021) and the Prediction of Sudden Death in Multi-Ethnic Communities (PRESTO, Ventura CA catchment pop 850K, 2015-2021), we performed a detailed evaluation of all sudden death cases that occurred within 1 year of pregnancy; including lifetime clinical history, SCA presentation and resuscitation outcome. Results: A total of 381 (46 in PRESTO and 335 in ORSUDS) sudden deaths occurred in females aged 15 to 49 years, and 17 of these (4.5%) occurred within a year of pregnancy. Pregnancy-related cases were between 21 and 39 years of age and included 7 non-Hispanic whites, 5 Hispanic/Latinos, 1 black, 1 Native American and 3 subjects of unknown race/ethnicity. Sudden cardiac arrest occurred while pregnant (6), during delivery (2), within 3 months post-partum (5) and a miscarriage (1), and between 3 and 9 months post-delivery (3). Only witnessed cases survived (4/17, 24%) and presented with both shockable rhythm (2) and non-shockable rhythm (2). Presumptive cause of death included 10 cardiac etiologies including presumed sudden arrhythmic death (4), coronary artery disease (2), left ventricular hypertrophy (1), severe mitral valve prolapse (1), myocardial fibrosis (1) and long QT syndrome (1). Non cardiac causes included drug overdose (2), obstetric thrombo-embolism (2), cerebro-vascular accident (2), and status asthmaticus (1). Conclusions: Our findings suggest that pre-existing heart disease is likely to be the most important risk factor for sudden unexpected death associated with pregnancy, and warrants further detailed investigation.