Pregnancy: When are pregnant women at highest risk for heart failure?
A study published January 12, 2018 in the journal Circulation: Heart Failure found that pregnant women are at the highest risk of heart failure six weeks after giving birth.
Heart failure is a significant cause of death and complications during and following pregnancy.
Characteristics associated with increased risk of heart failure in this group of women include high blood pressure, kidney failure, diabetes, anemia, valvular heart disease, prior history of heart failure, and a history of depression.
The classic risk factors for heart failure in all women are high blood pressure, history of heart attack, and, to a lesser extent, diabetes and obesity.
This study was seeking to describe the prevalence of heart failure as well as death in maternal outcomes. These were assessed in terms of where the women were in the course of pregnancy when presenting with heart failure — antepartum (before childbirth), peripartum (around the time of childbirth), or postpartum (after childbirth).
These data were obtained from a well-defined and comprehensive database with national and diverse representation. The study group included women from all phases of pregnancy. It was a registry review, so there was not necessarily longitudinal follow-up of an individual patient throughout the course of a pregnancy. The study period was 2001 to 2011.
The subjects were all pregnant women, characterized by standard demographics such as age, race, region, urban vs. nonurban, type of insurance, and household income.
Measurements included prevalence of heart failure and outcomes such as death and cardiovascular complications. Demographic and behavioral characteristics were also described.
Over the study period the prevalence of heart failure remained constant among women during the antepartum period. However, there were significant increases during the peripartum and postpartum periods. The diagnosis of heart failure was most common during the postpartum period. The risk of death was significantly associated with a diagnosis of heart failure during the peripartum and postpartum periods.
Yes. Women who were black, from urban neighborhoods, or in lower income groups were at higher risk for heart failure.
The researchers suggest that the increasing prevalence of heart failure in pregnancy may be due to the prevalence of risk factors such as high blood pressure, prior history of heart failure, and diabetes. This implies an increasing prevalence of those risk factors over the course of a pregnancy, which we know is the case for high blood pressure and diabetes, both of which cause chronic disease of the heart muscle.
This retrospective study describes associations, not cause-and-effect relationships. It provides significant information to prompt additional study as well as stimulate trials of appropriate interventions to prevent adverse outcomes.
This was a review of a well characterized national database using standard statistical methods. It appears to be a diverse and representative sample.
Given the significance of the postpartum period to the overall prevalence of heart failure in pregnant women, an attempt to define the incidence of peripartum heart disease (most frequently diagnosed in the early postpartum period) would have been useful.
Women who are at high-risk must be identified early and supervised following discharge after delivery. In addition, it may be time to design clinical trials for specific interventions in high risk groups.
Help with the Headlines is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health.
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