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Original research article
Maternal and fetal outcomes in pregnant women with heart failure
  1. Angie T Ng1,
  2. Lewei Duan2,
  3. Theresa Win1,
  4. Hillard T Spencer3,
  5. Ming-Sum Lee1
  1. 1 Division of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
  2. 2 Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
  3. 3 Southern California Permanente Medical Group, Los Angeles, California, USA
  1. Correspondence to Dr Ming-Sum Lee, Division of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA 90027, USA; mingsum.lee{at}


Objectives The goal of this study is to report the prevalence, aetiology and clinical outcome of pregnant women with heart failure.

Methods This is a retrospective community-based cohort study that included pregnant women in the Kaiser Permanente Health System between 2003 and 2014. Women with heart failure were identified using International Classification of Disease, Ninth Revision codes. Medical records were manually reviewed to confirm diagnosis and adjudicate outcomes.

Results In a cohort of 385 935 pregnancies, 488 (0.13%) had a diagnosis of heart failure, corresponding to 126 cases per 100 000 pregnancies. Peripartum cardiomyopathy was the most common cause of heart failure, accounting for 333 (68.2%) cases. Preterm birth and caesarean delivery were more common in patients with heart failure. Neonatal death rate was higher in the heart failure group (1.0% vs 0.4%, p=0.03). Infants delivered to women with heart failure had lower birth weights (3112.0±774.0 g vs 3331.9±575.5 g, p<0.001) and lower Apgar score at 1 min (7.9±1.5 vs 8.3±1.1, p<0.001). Median follow-up was 6.2 years (IQR 3.2–9.2). During follow-up, 7 (1.4%) in the heart failure group and 423 (0.11%) in the control group died. Heart failure was associated with a 7.7-fold increase risk of death (adjusted HR 7.7, 95% CI 3.6 to 16.4, p<0.001).

Conclusion Heart failure during pregnancy is associated with unfavourable fetal outcomes including prematurity and low birth weight. While the overall mortality rate was low, pregnant women with heart failure carried an excess risk of death compared with controls.

  • pregnancy
  • heart failure

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  • Contributors Study concept and design: AT-YN and M-SL. Acquisition, analysis or interpretation of data: AT-YN, LD, TW and M-SL. Drafting of the manuscript: AT-YN, HTS and M-SL. Critical revision of the manuscript for important intellectual content: AT-YN, LD, HTS and M-SL. Statistical analysis: LD and M-SL. Administrative, technical or material support: AT-YN, LD and TW. Study supervision: M-SL. All authors have access to the data and share responsibility for the published material.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The research protocol used in this study was reviewed and approved by the Kaiser Permanente Institutional Review Board.

  • Provenance and peer review Commissioned; externally peer reviewed.