Risk factors for heart failure during pregnancy among Chinese women with cardiac disease

OBJECTIVE: To identify risk factors for heart failure (HF) during pregnancy among women with pre-existing cardiac disease. METHODS: A retrospective review was conducted of pregnant women with cardiac disease who attended Shanghai Obstetrical Cardiology Intensive Care Center, China, for delivery between January 1, 1993, and December 31, 2013. Independent predictors of HF were identified by logistic regression analysis. RESULTS: Among 1086 pregnant women with cardiac disease, 116 (10.7%) developed HF. In multivariate analysis, HF was associated with left ventricular systolic dysfunction (odds ratio [OR] 13.16, 95% confidence interval [CI] 3.62-47.80; P<0.001), history of HF before pregnancy (OR 11.66, 95% CI 5.83-23.33; P<0.001), twin pregnancy (OR 11.63, 95% CI 4.10-32.99; P<0.001), sinus tachycardia (OR 4.60, 95% CI 2.77-7.62; P<0.001), New York Heart Association functional class higher than II (OR 3.36, 95% CI 1.11-10.25; P=0.033), and severe pulmonary arterial hypertension (OR 1.40, 95% CI 1.10-1.78; P=0.007). CONCLUSION: Women with cardiac disease who wish to become pregnant should be guided by risk factors for HF. Those who do conceive should be closely monitored during pregnancy to improve outcomes and reduce maternal mortality and morbidity.