Abstract
Background Although pregnancy-associated heart failure with preserved ejection fraction (HFpEF) is increasing
and contributing to maternal morbidity, little is known about its impact on pregnancy. We examined the risk factors
for and adverse pregnancy outcomes of HFpEF in pregnant women.
Methods We conducted a cross-sectional analysis of pregnancy-related hospitalizations from 2009 to 2020 using
the perinatal database of seven multicenters. Cases of HFpEF were identifed using the International Classifcation
of Diseases and echocardiography fndings. The patients were categorized into the HFpEF and control groups. Risk
factors were evaluated using multivariate logistic regression analysis to generate odds ratios (OR) and 95% confdence
intervals (CI). Furthermore, adjusted associations between HFpEF and adverse pregnancy outcomes were determined.
Risk scores for the stratifcation of women at a high risk of HFpEF were calculated using a statistical scoring model.
Results Of the 34,392 women identifed, 258 (0.76%) were included in the HFpEF group. In multivariate analysis,
HFpEF was signifcantly associated with old maternal age (OR, 1.04; 95% CI 1.02–1.07), multiple pregnancy (OR, 2.22;
95% CI 1.53–3.23), rheumatic disease (OR, 2.56; 95% CI 1.54–4.26), pregnancy induce hypertension (OR 6.02; 95%
CI 3.61–10.05), preeclampsia (OR 24.66; 95% CI 18.61–32.66), eclampsia or superimposed preeclampsia (OR 32.74;
95% CI 21.60–49.64) and transfusion in previous pregnancy (OR 3.89; 95% CI 1.89–8.01). A scoring model to predict
HFpEF with those factors achieved an area under the curve of 0.78 at cutof value of 3. Women with HFpEF also had
increased odds ratios of intensive care unit admission during the perinatal period (odds ratio, 5.98; 95% confdence
interval, 4.36–8.21) and of postpartum hemorrhage (Abstract
Background Although pregnancy-associated heart failure with preserved ejection fraction (HFpEF) is increasing
and contributing to maternal morbidity, little is known about its impact on pregnancy. We examined the risk factors
for and adverse pregnancy outcomes of HFpEF in pregnant women.
Methods We conducted a cross-sectional analysis of pregnancy-related hospitalizations from 2009 to 2020 using
the perinatal database of seven multicenters. Cases of HFpEF were identifed using the International Classifcation
of Diseases and echocardiography fndings. The patients were categorized into the HFpEF and control groups. Risk
factors were evaluated using multivariate logistic regression analysis to generate odds ratios (OR) and 95% confdence
intervals (CI). Furthermore, adjusted associations between HFpEF and adverse pregnancy outcomes were determined.
Risk scores for the stratifcation of women at a high risk of HFpEF were calculated using a statistical scoring model.
Results Of the 34,392 women identifed, 258 (0.76%) were included in the HFpEF group. In multivariate analysis,
HFpEF was signifcantly associated with old maternal age (OR, 1.04; 95% CI 1.02–1.07), multiple pregnancy (OR, 2.22;
95% CI 1.53–3.23), rheumatic disease (OR, 2.56; 95% CI 1.54–4.26), pregnancy induce hypertension (OR 6.02; 95%
CI 3.61–10.05), preeclampsia (OR 24.66; 95% CI 18.61–32.66), eclampsia or superimposed preeclampsia (OR 32.74;
95% CI 21.60–49.64) and transfusion in previous pregnancy (OR 3.89; 95% CI 1.89–8.01). A scoring model to predict
HFpEF with those factors achieved an area under the curve of 0.78 at cutof value of 3. Women with HFpEF also had
increased odds ratios of intensive care unit admission during the perinatal period (odds ratio, 5.98; 95% confdence
interval, 4.36–8.21) and of postpartum hemorrhage (odds ratio, 5.98; 95% confdence interval, 2.02–3.64).
Conclusions Pregnancy-associated HFpEF is associated with adverse pregnancy outcomes. A scoring model may
contribute to screening HFpEF using echocardiography and preparing adverse pregnancy outcomes.odds ratio, 5.98; 95% confdence interval, 2.02–3.64).
Conclusions Pregnancy-associated HFpEF is associated with adverse pregnancy outcomes. A scoring model may
contribute to screening HFpEF using echocardiography and preparing adverse pregnancy outcomes.
