Heart failure in pregnancy and postpartum: a nationwide study over 6.3 million of pregnancies in France between 2010 and 2018

Background: Cardiovascular diseases became the first cause of maternal death in France, but only scarce epidemiological data have been published about heart failure (HF) in pregnancy/postpartum. Objective: The aim of the present study was to describe the epidemiology of HF in pregnancy or until 6 weeks postpartum in France. Study Design: This is an observational cohort study. Using the French National Health Insurance Information System database (Système National des Données de Santé), all women who gave birth in France after 22 weeks of gestation between January 1, 2010, and December 31, 2018, were selected. HF hospitalizations occurring during the pregnancies or 6 weeks postpartum were identified. Results: On 6293,367 deliveries analyzed, 2241 (35.6/100,000) had at least one hospitalization for HF. This rate remained quite stable between 2010 and 2018. A total of 22.6% of these cases had heart disease history, including HF before pregnancy, and 49.0% had preceding or concomitant heart disease. Compared to women without HF, those with HF were older (32.0 [6.1] vs 29.9 [5.3] years), had more frequently multiple pregnancy (14.6% vs 1.7%), history of medically assisted reproduction (7.9% vs 3.2%), cardiovascular risk factors (arterial hypertension [17.0% vs 1.7%], gestational diabetes [15.5% vs 9.6%], obesity [14.9% vs 4.7%], tobacco smoking [12.4% vs 9.4%]), and had a lower socio-economic level with 23.4% living in the French most deprived area against 18.1% living in the least deprived area. The most frequent cardiac condition found were cardiomyopathy (29.5%), arrhythmias (14.0%), and valvulopathy (8.5%). The rate of pre-eclampsia reached 29.4% in pregnancies with HF against 2.0% in pregnancies without HF. Fetal complications were much higher in pregnancies with HF than without HF, with 11.5% vs 0.9% very/extremely preterm birth, and 5.3% vs 0.8% fetus/child death. One year after delivery, maternal death was observed in 2.2% of women with HF against <0.01% in those without HF. Conclusion: Despite occurring in only 1 in 2808 pregnancies, HF during pregnancy or the postpartum period has a significant impact on maternal and fetal outcomes.