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. 2019 Feb 20;14(2):e0211857.
doi: 10.1371/journal.pone.0211857. eCollection 2019.

Hypertensive disorders of pregnancy and peripartum cardiomyopathy: A nationwide cohort study

Ida Behrens  1 , Saima Basit  1 , Jacob A Lykke  2 , Mattis F Ranthe  1 , Jan Wohlfahrt  1 , Henning Bundgaard  3 , Mads Melbye  1   4 , Heather A Boyd  1
Affiliations

Hypertensive disorders of pregnancy and peripartum cardiomyopathy: A nationwide cohort study

Ida Behrens et al. PLoS One. .

Abstract

Background: Peripartum cardiomyopathy (PPCM) is a serious cardiac disorder occurring late in pregnancy or early in the postpartum period. We examined associations between hypertensive disorders of pregnancy (HDP: preeclampsia and gestational hypertension) and PPCM, accounting for other pregnancy-related risk factors for PPCM.

Methods: Using nationwide Danish register data, we constructed a cohort of all women with ≥1 live birth or stillbirth in Denmark between 1978 and 2012. Using log-linear binomial regression and generalized estimating equations, we estimated risk ratios (RRs) for PPCM associated with HDP of varying severity.

Results: In a cohort of 1,088,063 women with 2,078,822 eligible pregnancies, 126 women developed PPCM (39 in connection with an HDP-complicated pregnancy). The risks of PPCM were significantly higher in women with HDP-complicated pregnancies than in women with normotensive pregnancies (severe preeclampsia, RR 21.2, 95% confidence interval [CI] 12.0-37.4; moderate preeclampsia, RR 10.2, 95% CI 6.18-16.9; gestational hypertension, RR 5.16, 95% CI 2.11-12.6). The RRs for moderate preeclampsia and gestational hypertension were not significantly different from one another (p = 0.18); the RR for severe preeclampsia was significantly different from the RR for moderate preeclampsia and gestational hypertension combined (p = 0.02).

Conclusions: Although 70% of PPCM occurred in women with normotensive pregnancies, HDPs were associated with substantial increases in PPCM risk that depended on HDP severity. The heart's capacity to adapt to a normal pregnancy may be exceeded in some women already susceptible to cardiac insult, contributing to PPCM. HDPs, severe preeclampsia in particular, probably represent an additional cardiac stressor during pregnancy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Risk ratios, with 95% confidence intervals, for the association between severe preeclampsia, moderate preeclampsia, and gestational hypertension, and peripartum cardiomyopathy in the same pregnancy, among women with one or more birth in Denmark in the period 1978–2012.
Risk ratios are adjusted for parity, maternal age and calendar period at delivery, and multiple birth.
See this image and copyright information in PMC

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