(P-393) Pregnancy in Women with Heart Failure: A Cross-sectional Study in the Sentinel System

Background: Given the increase in blood volume and cardiac output, pregnancy poses significant risk of morbidity and mortality in women with underlying heart diseases, including heart failure (HF). Prior epidemiological studies concerning HF and pregnancy have mostly focused on HF-related encounters during peripartum and postpartum periods. It is not clear whether and how often women with pre-existing HF become pregnant.

Objectives: To estimate the prevalence of HF in women of childbearing age and the number of live birth and stillbirth pregnancies among these women.

Methods: Women aged 15 to 54 years with continuous medical and drug coverage for ≥ 480 days were identified in the FDA’s Sentinel System from January 2010 to February 2020. We used diagnosis and procedure codes to identify pregnancies ending in live birth or stillbirth deliveries. We included pregnancies of women who had evidence of qualifying HF diagnoses during the 180-day pre-pregnancy period or the first trimester, because new-onset HF in pregnant women rarely occurs during the first trimester. To understand the background rate of pregnancy in women with HF, we identified all childbearing age women with qualifying HF diagnoses in the database regardless of pregnancy status. Results were stratified by age group and calendar year.

Results: Among 29.5 million eligible women, we identified a total of 144,162 HF cases (prevalence, 0.5%). The prevalence of HF increased monotonically with age from 0.04% in women aged 15-19 years to 1.2% in women aged 50-54 years. Within this HF cohort, there were 836 women with 846 pregnancies ending in live birth or stillbirth deliveries (5.8 deliveries per 1,000 women with HF). The proportion of stillbirth deliveries was small (0.3 per 1,000 women with HF). Total live birth and stillbirth deliveries occurred more frequently among HF patients aged 20-24, 25-29, and 30-34 (26.5, 34.9, and 27.6 deliveries per 1,000 women with HF, respectively) compared to those in other age categories (0.3 to 14.4 deliveries per 1,000 women with HF). Across calendar years, the prevalence of HF remained stable (0.3%), as did the rate of deliveries (2.6 to 3.6 deliveries per 1,000 women with HF).

Conclusions: HF is rare among women of childbearing age and pregnancies only occurred in a small number of these women. Further study is needed to understand characteristics and outcomes of pregnancies among women with HF.