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Characteristics, Adverse Events, and Racial Differences Among Delivering Mothers With Peripartum Cardiomyopathy
Study Questions:
What are the clinical features and outcomes that are associated with peripartum cardiomyopathy (PPCM)?
Methods:
Hospital records were obtained from six states and screened for PPCM at time of delivery. Between January 2003 and December 2007, 39,829,857 hospital records were obtained from 620 different hospitals. Clinical profiles and outcomes with PPCM and without were compared and stratified by race. The primary outcome was a composite of major adverse events (MAE): death, cardiac arrest, heart transplantation, and/or mechanical circulatory support. Secondary outcomes included components of the primary outcome, length of hospital stay, cesarean delivery, and stillbirth.
Results:
A total of 535 hospital records from 243 different hospitals specified a diagnosis of PPCM with a delivery outcome. Those with PPCM were more likely to be older and African American with multiple gestations, preeclampsia, and eclampsia. Multivariate analysis demonstrated that age >30 years old, African American race, hypertension, anemia, substance abuse, asthma, multiple gestational status, preeclampsia, and eclampsia were associated with PPCM. The presence of PPCM was associated with a higher rate of MAE compared with the control group (odds ratio [OR], 436; p < 0.0001), as well as higher in-hospital mortality (OR, 175.2; p < 0.0001), longer length of stay, and higher likelihood of cesarean section (OR, 5.49; p < 0.0001) and stillbirth (OR, 3.47; p < 0.0001).
Conclusions:
The prevalence of PPCM at time of delivery in Hispanics is similar to Caucasians, and lower in African Americans. There is increased risk of adverse maternal events and stillbirth when PPCM is present at time of delivery.
Perspective:
This study confirms known risk factors for PPCM and also identifies new clinical features associated with PPCM at the time of delivery: anemia, substance abuse, asthma, and autoimmune disease. PPCM continues to be associated with increased risk of MAE and stillbirth at the time of delivery.
Keywords: Stillbirth, Puerperal Disorders, Autoimmune Diseases, Delivery, Obstetric, Heart Arrest, Substance-Related Disorders, Length of Stay, Cesarean Section, Pregnancy, Multiple, United States, Hypertension, Ethnic Groups, Hospital Mortality, Multivariate Analysis, Pre-Eclampsia, Hispanic Americans, Peripartum Period, Heart Transplantation, Heart Diseases, Blood Glucose, Heart Failure, Cardiomyopathy, Dilated
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