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Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study
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 pr...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5596930/ https://www.ncbi.nlm.nih.gov/pubmed/28899350 http://dx.doi.org/10.1186/s12884-017-1486-2 |
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author | Chang, Ying-Jen Ho, Chung-Han Chen, Jen-Yin Wu, Ming-Ping Yu, Chia-Hung Wang, Jhi-Joung Chen, Chia-Ming Chu, Chin-Chen |
author_facet | Chang, Ying-Jen Ho, Chung-Han Chen, Jen-Yin Wu, Ming-Ping Yu, Chia-Hung Wang, Jhi-Joung Chen, Chia-Ming Chu, Chin-Chen |
author_sort | Chang, Ying-Jen |
collection | PubMed |
description | 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: 24.20/10(5)). 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12884-017-1486-2) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5596930 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-55969302017-09-15 Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study Chang, Ying-Jen Ho, Chung-Han Chen, Jen-Yin Wu, Ming-Ping Yu, Chia-Hung Wang, Jhi-Joung Chen, Chia-Ming Chu, Chin-Chen BMC Pregnancy Childbirth Research Article 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: 24.20/10(5)). 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12884-017-1486-2) contains supplementary material, which is available to authorized users. BioMed Central 2017-09-12 /pmc/articles/PMC5596930/ /pubmed/28899350 http://dx.doi.org/10.1186/s12884-017-1486-2 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Chang, Ying-Jen Ho, Chung-Han Chen, Jen-Yin Wu, Ming-Ping Yu, Chia-Hung Wang, Jhi-Joung Chen, Chia-Ming Chu, Chin-Chen Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study |
title | Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study |
title_full | Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study |
title_fullStr | Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study |
title_full_unstemmed | Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study |
title_short | Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study |
title_sort | epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in taiwan: a retrospective nationwide study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5596930/ https://www.ncbi.nlm.nih.gov/pubmed/28899350 http://dx.doi.org/10.1186/s12884-017-1486-2 |
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