Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study

BMC Pregnancy Childbirth. 2017 Sep 12;17(1):302. doi: 10.1186/s12884-017-1486-2.

Abstract

Background: During pregnancy, the hyperdynamic physiology of circulation can exacerbate many cardiovascular disorders. Congestive heart failure (CHF) usually occurs during late pregnancy, which is significantly associated with a high level of maternal and neonatal morbidities and mortalities. The profile of women who develop peripartum CHF (PCHF) is unknown. We investigated the epidemiological profiles of PCHF.

Methods: In this retrospective cohort study, PCHF patients were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in Taiwan's National Health Insurance Research Database. Risk factors and obstetric outcomes were compared in women with and without PCHF.

Results: From 2,115,873 birth-mothers in Taiwan between 1997 and 2013, we identified 512 with PCHF (incidence: 24.20/105). More women with than without PCHF were older (≥ 35, 18.16% vs. 9.62%), and had more multifetal gestations (7.42% vs. 1.40%), gestational hypertension (HTN) (19.2% vs. 1.31%), and gestational diabetes mellitus (4.10% vs. 0.67%). After the analysis had been adjusted for confounders, the leading comorbidities associated with PCHF were structural heart diseases (adjusted odds ratio [aOR]: 67.21; 95% confidence interval [CI]: 54.29-83.22), pulmonary diseases (aOR: 13.12; 95% CI: 10.28-16.75), chronic HTN (aOR: 11.27; 95% CI: 6.94-18.28), thyroid disease (aOR: 9.53; 95% CI: 5.27-17.23), and gestational HTN (aOR: 5.16; 95% CI: 3.89-6.85). PCHF patients also had a higher rate of cesarean sections (66.41% vs. 34.46%; p < 0.0001).

Conclusion: Maternal structural heart diseases, pulmonary diseases, thyroid disorders, and preexisting or gestational HTN are associated with a higher risk of developing PCHF. Birth-mothers with PCHF also had a higher risk of caesarean section and adverse outcomes, including maternal death. Our findings should benefit healthcare providers, and government and health insurance policy makers.

Keywords: Congestive heart failure; Epidemiological; Obstetric outcomes; Peripartum.

MeSH terms

  • Adult
  • Age Factors
  • Cesarean Section / statistics & numerical data
  • Comorbidity
  • Diabetes, Gestational / epidemiology
  • Female
  • Heart Defects, Congenital / epidemiology*
  • Heart Failure / epidemiology*
  • Humans
  • Hypertension, Pregnancy-Induced / epidemiology*
  • Incidence
  • Lung Diseases / epidemiology*
  • Peripartum Period
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / epidemiology*
  • Pregnancy, Multiple / statistics & numerical data
  • Retrospective Studies
  • Risk Factors
  • Taiwan / epidemiology
  • Thyroid Diseases / epidemiology*
  • Young Adult