Characteristics, Adverse Events, and Racial Differences Among Delivering Mothers With Peripartum Cardiomyopathy

Abstract

Objectives To identify clinical features associated with peripartum cardiomyopathy (PPCM) and possible racial differences, and to quantify in-hospital outcomes in delivering mothers with PPCM. Background Investigation of patient characteristics and outcomes in PPCM has been limited to small cohorts. Hospital discharge data allows assembly of the largest number of PPCM cases to date. Methods Hospital records from six states were screened for PPCM. Clinical profiles, maternal, and fetal outcomes in delivering mothers with and without PPCM were compared and stratified by race. A maternal major adverse event (MAE) was defined as death, cardiac arrest, heart transplantation, or mechanical circulatory support. Logistic regression was used to identify variables associated with PPCM. Results In total, 535/4,003,914 records of delivering mothers specified a diagnosis of PPCM. Prevalence of PPCM was highest among African-Americans and similar in Caucasians and Hispanics. Established risk factors including age ≥ 30 years, African-American race, hypertension, preeclampsia/eclampsia, and multigestational status were associated with PPCM, and novel associations such as anemia and asthma were identified. Autoimmune disease and substance abuse, which can cause cardiomyopathy independently, were also associated with PPCM. Maternal MAE (odds ratio=436, p<0.0001) and stillbirth (odds ratio=3.8, p<0.0001) occurred more frequently among women with PPCM. Conclusions The prevalence of PPCM at the time of delivery in Hispanics was similar to Caucasians and lower than African-Americans. Autoimmune disease, substance abuse, anemia and asthma were conditions associated with PPCM not consistently identified in smaller cohorts. PPCM was also associated with increased risk of stillbirth and maternal MAEs at delivery.

Peripartum Cardiomyopathy

“…Mean birth weight, size, and Apgar scores are lower in neonates born to women with PPCM, likely reflecting earlier gestational age at delivery. 17 Stillbirths are more common (odds ratio, 3.8; P<0.0001 in a population study of 535 patients 32 ). Decisions on management and timing and mode of delivery should therefore be made by a team of cardiologists and obstetricians.…”

“…A recent study of hospital discharge records in 6 states identified 535 patients with PPCM, of whom 29.3% had preeclampsia and 46.9% had hypertension (odds ratio, 13.6 and 13.4, respectively). 32 The prevalence of preeclampsia in many of these studies may be underestimated because preeclampsia is often underreported and misclassified and because the presence of preeclampsia is often used as an exclusion criterion from the diagnosis of PPCM. PPCM is also frequently found in association with eclampsia, with an odds ratio of 12.9 in a California population study of 1888 patients with eclampsia 33 and 27.9 in the multistate hospital discharge study of PPCM cases noted above.…”

“…Recent national inpatient databases reveal in-hospital mortalities of 1.3%, 18,32 but they do not include postdischarge information. Longer-term follow-up in 100 patients in 2 Midwestern academic centers showed a mortality of 11% over a mean of 8 years.…”

Peripartum cardiomyopathy: an obstetric review

“…[8][9][10][11] In the United States, the lowest observed incidence is reported in Hispanics and the highest in AfricanAmericans. 12 The Peripartum Cardiomyopathy Project in Haiti estimates the incidence of PPCM to be as high as 1 in 299 live births. 13 A study conducted in a tertiary hospital in South India reported an incidence of 1case per 1374 deliveries, with advanced maternal age and multiparity being the foremost risk factors.…”

“…10,12,[15][16][17][18] Although initially considered to be a variant of dilated cardiomyopathy, it is now accepted that PPCM is a distinct entity rather than a clinically silent underlying cardiomyopathy exacerbated by the hemodynamic changes during pregnancy. The two-share common clinical presentation and hemodynamic features, yet several distinctive features set them apart.…”