Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study

doi:10.1186/s12884-017-1486-2

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標題:	Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study
作者:	Chang, Ying-Jen Ho, Chung-Han Chen, Jen-Yin Wu, Ming-Ping Yu, Chia-Hung Wang, Jhi-Joung Chen, Chia-Ming Chu, Chin-Chen
貢獻者:	Chi Mei Med Ctr, Dept Anesthesiol Chi Mei Med Ctr, Dept Med Res Chia Nan Univ Pharm & Sci, Dept Pharm Chia Nan Univ Pharm & Sci, Dept Senior Citizen Serv Management Chi Mei Med Ctr, Div Urogynecol & Pelv Floor Reconstruct, Dept Obstet & Gynecol Chia Nan Univ Pharm & Sci, Ctr Gen Educ Chia Nan Univ Pharm & Sci, Dept Recreat & Hlth Care Management Chi Mei Med Ctr, Div Womens & Childrens Anesthesia, Dept Anesthesiol
關鍵字:	Congestive heart failure Peripartum Epidemiological Obstetric outcomes
日期:	2017-09-12
上傳時間:	2018-11-30 15:49:54 (UTC+8)
出版者:	Biomed Central Ltd
摘要:	Background: During pregnancy, the hyperdynamic physiology of circulation can exacerbate many cardiovascular disorders. Congestive heart failure (CHF) usually occurs during late pregnancy, which is significantly associated with a high level of maternal and neonatal morbidities and mortalities. The profile of women who develop peripartum CHF (PCHF) is unknown. We investigated the epidemiological profiles of PCHF. Methods: In this retrospective cohort study, PCHF patients were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in Taiwan's National Health Insurance Research Database. Risk factors and obstetric outcomes were compared in women with and without PCHF. Results: From 2,115,873 birth-mothers in Taiwan between 1997 and 2013, we identified 512 with PCHF (incidence: 24. 20/ 105). More women with than without PCHF were older (>= 35, 18.16% vs. 9.62%), and had more multifetal gestations (7.42% vs. 1.40%), gestational hypertension (HTN) (19.2% vs. 1.31%), and gestational diabetes mellitus (4.10% vs. 0.67%). After the analysis had been adjusted for confounders, the leading comorbidities associated with PCHF were structural heart diseases (adjusted odds ratio [aOR]: 67.21; 95% confidence interval [CI]: 54.29-83.22), pulmonary diseases (aOR: 13.12; 95% CI: 10.28-16.75), chronic HTN (aOR: 11.27; 95% CI: 6.94-18.28), thyroid disease (aOR: 9.53; 95% CI: 5.27-17.23), and gestational HTN (aOR: 5.16; 95% CI: 3.89-6.85). PCHF patients also had a higher rate of cesarean sections (66.41% vs. 34.46%; p < 0.0001). Conclusion: Maternal structural heart diseases, pulmonary diseases, thyroid disorders, and preexisting or gestational HTN are associated with a higher risk of developing PCHF. Birth-mothers with PCHF also had a higher risk of caesarean section and adverse outcomes, including maternal death. Our findings should benefit healthcare providers, and government and health insurance policy makers.
關聯:	BMC Pregnancy and Childbirth, v.17:302
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