Study Identifies Novel Risk Factors for Peripartum Cardiomyopathy

“If they have anemia or asthma, worry about those patients because they may get into trouble and adverse events may be greater,” said Peter Block, MD, FACC.

A study of clinical features, racial differences and major adverse events associated with delivering babies of mothers with peripartum cardiomyopathy (PPCM) identified novel risk factors for PPCM. The study, published Sept. 11 in Journal of the American College of Cardiology: Heart Failure , found the highest prevalence of PPCM among African-American mothers and an increased risk of stillbirth and maternal major adverse events at delivery among mothers with PPCM compared with those without PPCM.

The study is the largest number of PPCM cases studied to date, and evaluated the hospital records of 535 delivering mothers from 243 hospitals in six states who were diagnosed with PPCM. It compared clinical profiles and maternal and fetal outcomes stratified by race with records of delivering mothers without PPCM.

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In addition to established risk factors for PPCM – age ≥30 years, African-American race, hypertension, preeclampsia/eclampsia and multigestational status – the authors found novel associations with PPCM: anemia and asthma. Other conditions found to be associated with PPCM were substance abuse and autoimmune disease, including systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, polymyositis, Wegener’s granulomatosis, Takayasu’s arteritis, ulcerative colitis and/or Crohn’s disease.

The prevalence of PPCM at the time of delivery was highest among African-Americans, with lower, but similar, rates among Hispanics and Caucasians. The rate of PPCM present at delivery increased exponentially with each additional risk factor associated with PPCM, and the rate was about 800 times greater among mothers with ≥6 factors than in those with none (p < 0.0001).

Among the PPCM mothers, 6.7 percent had major adverse events (composite of death, cardiac arrest, heart transplantation or mechanical circulatory support) compared with 0.02 percent in the mothers without PPCM (p < 0.0001). The presence of PPCM in mothers at delivery was associated with higher in-hospital mortality, longer lengths of stay, a higher likelihood of delivery by Cesarean section and stillbirth compared with mothers without PPCM (p < 0.0001). Heart transplantations or mechanical circulatory support were not reported among the PPCM mothers.

“Peripartum cardiomyopathy is associated with a number of demographic and comorbid conditions, including advanced maternal age, African-American race, hypertension, anemia, substance abuse, asthma, autoimmune disease, multigestational status, preeclampsia, and eclampsia, with some racial differences,” the authors conclude.

Keywords: Lupus Erythematosus, Systemic, Stillbirth, Risk Factors, Heart Arrest, Crohn Disease, Substance-Related Disorders, Prevalence, Takayasu Arteritis, Polymyositis, Cardiomyopathies, Eclampsia, Cesarean Section, Hypertension, Pregnancy, Maternal Age, Hospital Mortality, Pre-Eclampsia, Hispanic Americans, Peripartum Period, Heart Transplantation, Colitis, Ulcerative, Granulomatosis with Polyangiitis, Dermatomyositis

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