Archives of Gynecology and Obstetrics

, Volume 300, Issue 6, pp 1613–1619 | Cite as

Precipitating factors and maternal and neonatal outcomes of heart failure in pregnancy: a retrospective analysis in a large tertiary hospital in China, 2012–2017

  • Hengxi Chen
  • Xiaodong Wang
  • Haiyan YuEmail author
Maternal-Fetal Medicine



To investigate the precipitating factors of heart failure (HF) and to investigate the maternal and neonatal outcomes in pregnant women with HF.


We reviewed the medical records of pregnant women with HF who were treated at West China Second University Hospital between September 2012 and September 2017. We recorded baseline characteristics, onset and treatment of HF, comorbidities, modes of delivery, and maternal and fetal mortality and morbidity. Chi-square tests or Fisher’s exact tests were used to explore the comorbidities in different subgroups.


Seventy pregnant women with HF were identified. The most common pregnancy-specific conditions were severe preeclampsia (36/70, 51.43%) and multiple pregnancies (16/70, 22.86%). The most common nonpregnancy-specific conditions were lung infections (34/70, 48.57%) and cardiac problems (25/70, 35.71%). Sixty patients (85.71%) developed HF during pregnancy. Sixty-seven pregnancies (95.71%) ended in cesarean section. Three maternal deaths (4.29%) from HF were recorded. Of the 87 fetuses, three fetuses (3.45%) ended in miscarriages and stillbirth occurred in 5.75% of fetuses. The mean birth weight of a neonate was 2174.49 ± 609.57 (817–3430) g. There were eight neonatal deaths (8/79, 10.13%). The incidence of lung infection (P = 0.031) or cardiac problems (P = 0.044) differs between patients with NYHA classes II and patients with NYHA classes III/IV. The incidence of lung infection (P = 0.006) was also different in patients with prenatal HF and patients with postpartum HF.


Peripartum HF is associated with high maternal and neonatal morbidity and mortality. Hypertensive disorders in pregnancy, lung infections, and cardiac problems are most common precipitating factors of HF in pregnancy.


Pregnancy Heart failure Comorbidities Mortality Morbidity 



We thank Eranga Harshika Abeysundera for polishing the language.

Authors’ contribution

HC was involved in project development, data collection, data analysis, and manuscript writing. HY was involved in data collection, data analysis, and manuscript editing. XW was involved in manuscript editing.


This study was supported by the Academic and Technical Leader’s Foundation of Sichuan Province (No. 2016-183-31).

Compliance with ethical standards

Conflict of interest

The authors declared no potential conflicts of interest.

Ethical approval

This retrospective study was approved by the Institutional Review Board of West China Second University Hospital.

Research involving human participants and/or animals

For this type of study, formal consent is not required. This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Lima FV, Yang J, Xu J, Stergiopoulos K (2017) National trends and in-hospital outcomes in pregnant women with heart disease in the United States. Am J Cardiol 119(10):1694–1700CrossRefGoogle Scholar
  2. 2.
    Pang PS, Komajda M, Gheorghiade M (2010) The current and future management of acute heart failure syndromes. Eur Heart J 31:784–793CrossRefGoogle Scholar
  3. 3.
    Ahmad WA, Khanom M, Yaakob ZH (2011) Heart failure in pregnancy: an overview. Int J Clin Pract 65(8):848–851CrossRefGoogle Scholar
  4. 4.
    Rudiger A, Harjola VP, Müller A, Mattila E, Säila P, Nieminen M, Follath F (2014) Acute heart failure: clinical presentation, one-year mortality and prognostic factors. Eur J Heart Fail 7(4):662–670CrossRefGoogle Scholar
  5. 5.
    People’s Republic of China national health and Family Planning Commission (2015). The death of pregnant women in China The rate of death is one year ahead of time to achieve the United Nations Millennium Development Goals. Accessed March 20, 2015
  6. 6.
    Stangl V, Schad J, Gossing G, Borges A, Baumann G, Stangl K (2008) Maternal heart disease and pregnancy outcome: a single-centre experience. Eur J Heart Fail 10:855–860CrossRefGoogle Scholar
  7. 7.
    Fu Q, Lin J (2015) Risk factors for heart failure during pregnancy among Chinese women with cardiac disease. Int J Gynecol Obstet 130(3):266–269CrossRefGoogle Scholar
  8. 8.
    Barasa A, Rosengren A, Sandstrom TZ, Ladfors L, Schaufelberger M (2017) Heart failure in late pregnancy and postpartum: incidence and long-term mortality in Sweden From 1997 to 2010. J Card Fail 23(5):370–378CrossRefGoogle Scholar
  9. 9.
    Ghossein-Doha C, Van NJ, Wissink B, Breetveld NM, de Windt LJ, van Dijk AP, Janssen MC, Heidema WM, Scholten RR, Spaanderman ME (2017) Pre-eclampsia: an important risk factor for asymptomatic heart failure. Ultrasound Obstet Gynecol 49(1):143–149CrossRefGoogle Scholar
  10. 10.
    Elkayam U (2011) Clinical characteristics of peripartum cardiomyopathy in the United States: diagnosis, prognosis, and management. J Am Coll Cardiol 58(7):659–670CrossRefGoogle Scholar
  11. 11.
    Ruys TP, Roos-Hesselink JW, Hall R, Subirana-Domènech MT, Grando-Ting J, Estensen M, Crepaz R, Fesslova V, Gurvitz M, De Backer J, Johnson MR, Pieper PG (2014) Heart failure in pregnant women with cardiac disease: data from the ROPAC. Heart 100(3):231–238CrossRefGoogle Scholar
  12. 12.
    Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, Kells CM, Bergin ML, Kiess MC, Marcotte F, Taylor DA, Gordon EP, Spears JC, Tam JW, Amankwah KS, Smallhorn JF, Farine D, Sorensen S, Cardiac Disease in Pregnancy (CARPREG) Investigators (2001) Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 104(5):515–521CrossRefGoogle Scholar
  13. 13.
    Hsich EM, Pina IL (2009) Heart failure in women: a need for prospective data. J Am Coll Cardiol 54(6):491–498CrossRefGoogle Scholar
  14. 14.
    Huisman CM, Zwart JJ, Roos-Hesselink JW, Duvekot JJ, van Roosmalen J (2013) Incidence and predictors of maternal cardiovascular mortality and severe morbidity in The Netherlands: a prospective cohort study. PLoS ONE 8(2):e56494CrossRefGoogle Scholar
  15. 15.
    Kuleva M, Youssef A, Maroni E, Contro E, Pilu G, Rizzo N, Pelusi G, Ghi T (2011) Maternal cardiac function in normal twin pregnancy: a longitudinal study. Ultrasound Obstet Gynecol 38(5):575–580CrossRefGoogle Scholar
  16. 16.
    McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, ESC Committee ESC Committee for Practice Guidelines (2012) ESC guidelines for the diagnosis and treatment of acute and chronic HF 2012: the task force for the diagnosis and treatment of acute and chronic HF 2012 of the European Society of Cardiology. Developed in collaboration with the HF Association (HFA) of the ESC. Eur J Heart Fail 14(8):803–869CrossRefGoogle Scholar
  17. 17.
    Uebing A, Steer PJ, Yentis SM, Gatzoulis MA (2006) Pregnancy and congenital heart disease. BMJ 332(7538):401–406CrossRefGoogle Scholar
  18. 18.
    Li HT, Luo S, Trasande L, Hellerstein S, Kang C, Li JX, Zhang Y, Liu JM, Blustein J (2017) Geographic variations and temporal trends in cesarean delivery rates in China, 2008–2014. JAMA 317(1):69–76CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyWest China Second University Hospital, Sichuan UniversityChengduChina
  2. 2.Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of EducationSichuanChina

Personalised recommendations