Epidemiology of Peripartum Cardiomyopathy Incidence, Predictors, and Outcomes

Department of Medicine, University of California, San Francisco, San Francisco, California, United States
Obstetrics and Gynecology (Impact Factor: 5.18). 09/2011; 118(3):583-91. DOI: 10.1097/AOG.0b013e318229e6de
Source: PubMed


To estimate the incidence, describe the mortality, and identify independent predictors of peripartum cardiomyopathy, a very serious cardiovascular complication of pregnancy associated with maternal morbidity and mortality among otherwise healthy women without prior heart disease.
We identified all cases of diagnosed heart failure that occurred among women within 1 month before to 5 months after delivery of a liveborn neonate in Kaiser Permanente Northern California delivery hospitals between 1995 and 2004. Incident peripartum cardiomyopathy was confirmed from medical records documenting dilated cardiomyopathy with reduced left ventricular systolic function after excluding women with prior heart failure or valvular disease. Data sources included medical records, electronic clinical databases, and state birth and death files.
Among 227,224 eligible women, we confirmed 110 recognized peripartum cardiomyopathy cases (incidence: 4.84 per 10,000 live births, 95% confidence interval 3.98-5.83). Independent predictors included maternal age of 25 years or older, non-Hispanic African American and Filipino groups, parity of 4 or greater, multiple gestation, severe anemia, pre-existing and pregnancy-related hypertensive disorders, and hemolysis, elevated liver enzymes, low platelets syndrome. Maternal death rate (per 1,000 person-years) was higher among cases (6.12) than noncases (0.23; P<.001). Neonates whose mothers developed peripartum cardiomyopathy experienced poorer clinical outcomes.
Within a large, diverse northern California population, 1 of every 2,066 women delivering a liveborn neonate had recognized, confirmed peripartum cardiomyopathy, which was associated with higher maternal and neonatal death rates and worse neonatal outcomes. Several readily available patient characteristics can be used to identify women at risk for this severe pregnancy complication.

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Available from: Erica P Gunderson, Feb 22, 2015
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    • "Peripartum cardiomyopathy (PPCM) is a rare condition, with an incidence estimated to be around 1 in 2000 live births, and is associated with high rates of maternal and neonatal morbidity and mortality [3]. It is characterized by the deterioration of left ventricular systolic function towards the end of pregnancy, or in the postnatal period in the absence of another cause for heart failure [2]. "
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    ABSTRACT: Introduction Cardiac disease is the leading cause of maternal death in the United Kingdom. Peripartum cardiomyopathy (PPCM) accounts for about 17% of these deaths. We present a series of five women who presented with PPCM in Lanarkshire in recent years. Their presentations were variable clinically, and so, represent an important diagnostic challenge. Discussion Peripartum cardiomyopathy is an uncommon disease of pregnancy, characterised by the development of heart failure, due to left ventricular systolic dysfunction. The incidence of PPCM is estimated to be around 1 in 2000 live births, and is associated with high rates of maternal and neonatal mortality. Several predisposing factors have been identified, with genetics posited as having a key role in some subtypes. The pathophysiology is unclear. Recent evidence suggests a causative role for a cleavage product of prolactin, since protection is conferred by inhibition of prolactin by administration of bromocriptine in models and in pilot trials. Autoimmunity directed against cardiac beta-1-adrenoreceptors has also been implicated, and experimental evidence shows some potential for therapeutic intervention. Diagnosis is mainly clinical, though findings are often masked by the normal physiological changes seen in pregnancy. Favourable prognosis is dependent on recovery of left ventricular function: full recovery occurs in around half of cases, though significant percentage of cases results in persistent cardiomyopathy or mortality. The rate of recurrence is high in subsequent pregnancies. Due to its rarity, variability in presentation, and potential for mortality, PPCM should be considered in women at high risk, or presenting with suggestive symptoms.
    12/2013; 2013(Suppl 1):563158. DOI:10.1155/2013/563158

  • International journal of cardiology 09/2011; 153(1):1-3. DOI:10.1016/j.ijcard.2011.09.001 · 4.04 Impact Factor
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    ABSTRACT: Pregnancy is associated with marked maternal cardiovascular/hemodynamic changes. A greater number of pregnancies may be associated with long-term subclinical changes in left ventricular (LV) remodeling. Among 2,234 white, black, Hispanic, and Chinese women (mean age 62 years) in the MESA, we used linear regression to relate live births and cardiac magnetic resonance imaging LV measures. Covariates included age, ethnicity, height, income, education, birth country, smoking, menopause, and oral contraceptive duration. Models were additionally adjusted for potential mediators: systolic blood pressure, antihypertensive use, total/high-density lipoprotein cholesterol, triglycerides, diabetes, and body mass index. We performed sensitivity analyses excluding 763 women in the lowest socioeconomic group: annual income <$25,000 and lower high school level of education. With each live birth, LV mass increased 1.26 g; LV end-diastolic volume, 0.74 mL; and LV end-systolic volume, 0.45 mL; LV ejection fraction decreased 0.18% (P trend <0.05). Changes were most notable for the category of women with ≥5 pregnancies. Upon adjustment for potential biologic mediators, live births remained positively associated with LV mass and end-systolic volume. Live births remained significantly associated with LV end-systolic, end-diastolic volumes, and LV mass (P trend ≤0.02) after excluding women in the lowest socioeconomic group. Number of live births is associated with key LV structural and functional measures in middle to older ages, even after adjustment for sociodemographic factors and cardiovascular disease risk factors. Hemodynamic changes during pregnancy may be associated with cardiac structure/function beyond childbearing years.
    American heart journal 03/2012; 163(3):470-6. DOI:10.1016/j.ahj.2011.12.011 · 4.46 Impact Factor
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