Heart failure in pregnancy: A review of clinical status and meta-analysis of diagnosis and medication safety

Despite progressive improvements in pregnancy-related health care in high-income countries and the concomitant decline in maternal mortality, heart failure (HF) remains a principal cause of non-obstetric maternal deaths in women with a pre-existing or undiagnosed cardiac disease. Although a structurally and functionally normal heart tolerates pregnancy-related physiological stress, the presence of cardiac diseases can deteriorate cardiac function leading to HF (the inability of the heart to function as a pump). With increasing ageing obstetric population, obesity, immigration and survival to adulthood of babies operated for congenital heart disease, the need to identify women at risk of developing heart failure in pregnancy (HFP) and to plan their careful management will also inevitable increase. Thus, in pursuit of safe motherhood, there is a need for a better understanding of aetiology, risk factors, pathophysiology, diagnosis and management of HFP. In the present paper, we review published evidence on HFP to advance the understanding of its clinical status as well as to highlight areas of limited knowledge that could benefit from additional research.