A 20-Year Population Study of Peripartum Cardiomyopathy

Quick Takes

  • Risk factors for peripartum cardiomyopathy include obesity, gestational hypertensive disorders, and multiple gestation pregnancies.
  • Long-term outcomes for patients with peripartum cardiomyopathy in Scotland included a mortality rate of 8% and recovery of 76%.

Study Questions:

What are the epidemiology patterns and long-term outcomes of peripartum cardiomyopathy (PPCM) in Europe?

Methods:

This was a retrospective, observational, population-level study of patients hospitalized with presumed PPCM in Scotland from 1998–2017. Each case was matched to 10 age-matched controls. Incidence, risk factors, morbidity, and mortality were examined.

Results:

In Scotland, the incidence of PPCM was 1 in 4,950 deliveries, with higher risks in patients with obesity, gestational hypertensive disorders, and multiple gestation pregnancies. There was a median follow-up of 8.3 years, mortality was 8%, rehospitalization was 75%, and composite outcome (all-cause death, mechanical circulatory support, or cardiac transplantation) was 14%. Recovery of myocardial function occurred in 76%; of these, 13% had subsequent decline in systolic cardiac function. Children born to women with PPCM had 5 times higher mortality than those born to controls.

Conclusions:

PPCM occurred in 1 in 4,950 deliveries and was associated with morbidity and mortality for both mother and baby.

Perspective:

This study highlights the significant morbidity and mortality related to PPCM. The data analyzed were from the National Health Service, which covers nearly all health care in Scotland, providing a rich source of information about the incidence and natural history of PPCM. Previously recognized risk factors included gestational hypertensive disorders, obesity, and multiple gestational pregnancies. The recovery rate was 76%; however, 13% had subsequent decline in function, highlighting the importance of long-term follow-up for patients, even after presumed recovery. The increased risk of infant morbidity and mortality was also significant. Ongoing long-term follow-up after PPCM is essential.

Clinical Topics: Heart Failure and Cardiomyopathies

Keywords: Cardiomyopathies, Infant Mortality, Peripartum Period


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