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. 2022 May;35(10):1891-1898.
doi: 10.1080/14767058.2020.1773784. Epub 2020 Jun 7.

Racial disparities in peripartum cardiomyopathy: eighteen years of observations

Rachel G Sinkey  1   2 , Indranee N Rajapreyar  3 , Jeff M Szychowski  1   2   4 , Emily K Armour  1   2 , Zachary Walker  1   2 , Marc G Cribbs  3 , Tera F Howard  1   2 , Luisa A Wetta  1   2 , Akila Subramaniam  1   2 , Alan T Tita  1   2
Affiliations

Racial disparities in peripartum cardiomyopathy: eighteen years of observations

Rachel G Sinkey et al. J Matern Fetal Neonatal Med. 2022 May.

Abstract

Background: Black women have greater than a three-fold risk of pregnancy-associated death compared to White women; cardiomyopathy is a leading cause of maternal mortality.

Objectives: This study examined racial disparities in health outcomes among women with peripartum cardiomyopathy.

Study design: Retrospective cohort of women with peripartum cardiomyopathy per the National Heart, Lung, and Blood Institute definition from January 2000 to November 2017 from a single referral center. Selected health outcomes among Black and White women were compared; primary outcome was ejection fraction at diagnosis. Secondary outcomes included cardiovascular outcomes, markers of maternal morbidity, resource utilization, and subsequent pregnancy outcomes.

Results: Ninety-five women met inclusion criteria: 48% Black, 52% White. Nearly all peripartum cardiomyopathy diagnoses were postpartum (95.4% Black, 93% White, p=.11). Ejection fraction at diagnosis was not different between Black and White women (26.8 ± 12.5 vs. 28.7 ± 9.9, p=.41). Though non-significant, fewer Black women had myocardial recovery to EF ≥55% (35 vs. 53%, p=.07); however, 11 (24%) of Black women vs. 1 (2%) White woman had an ejection fraction ≤35% at 6-12 months postpartum (p<.01). More Black women underwent implantable cardioverter defibrillator placement: n = 15 (33%) vs. n = 7 (14%), p=.03. Eight women (8.4%) died in the study period, not different by race (p=.48). Black women had higher rates of healthcare utilization. In the subsequent pregnancy, Black women had a lower initial ejection fraction (40 vs. 55%, p=.007) and were less likely to recover postpartum (37.5 vs. 55%, p=.02).

Conclusions: Black and White women have similar mean ejection fraction at diagnosis of peripartum cardiomyopathy, but Black women have more severe left ventricular systolic dysfunction leading to worse outcomes, increased resource use, and lower ejection fraction entering the subsequent pregnancy.

Keywords: Maternal morbidity; maternal mortality; peripartum cardiomyopathy; racial disparities.

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Conflict of interest statement

Declaration of Interest Statement

The authors report no conflict of interest.

Figures

Figure 1
Figure 1. Flow diagram of included patients
Flow diagram depicting women included in the study after application of inclusion and exclusion criteria. Key study findings include: 1) Black and white women had similar mean EF at diagnosis: 26.8 ± 12.5 vs 28.7 ± 9.9, p=0.41, respectively; 2) 24% of Black women and 2% of White women had persistent left systolic dysfunction ≤ 35 % at 6-12 months postpartum (p = 0.0006), and 3) 33% of Black women had ICD placement compared to 14% of White women (p = 0.03). PPCM = peripartum cardiomyopathy; NHLBI = National Heart, Lung and Blood Institute; EF = ejection fraction; ICD = implantable cardioverter defibrillator
See this image and copyright information in PMC

References

    1. Petersen EE, Davis NL, Goodman D, et al. Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017. MMWR Morbidity and mortality weekly report. 2019. May 10;68(18):423–429. doi: 10.15585/mmwr.mm6818e1.. eng. - DOI - PMC - PubMed
    1. Whitehead SJ, Berg CJ, Chang J. Pregnancy-related mortality due to cardiomyopathy: United States, 1991–1997. Obstetrics and gynecology. 2003. Dec;102(6):1326–31. doi: 10.1016/j.obstetgynecol.2003.08.009.; eng. - DOI - PubMed
    1. Harper MA, Meyer RE, Berg CJ. Peripartum cardiomyopathy: population-based birth prevalence and 7-year mortality. Obstetrics and gynecology. 2012. Nov;120(5):1013–9. doi: http://10.1097/AOG.0b013e31826e46a110.1097/aog.0b013e31826e46a1.; eng. - DOI - PubMed
    1. Goland S, Modi K, Hatamizadeh P, et al. Differences in clinical profile of African-American women with peripartum cardiomyopathy in the United States. Journal of cardiac failure. 2013. Apr;19(4):214–8. doi: 10.1016/j.cardfail.2013.03.004.; eng. - DOI - PubMed
    1. McNamara DM, Elkayam U, Alharethi R, et al. Clinical Outcomes for Peripartum Cardiomyopathy in North America: Results of the IPAC Study (Investigations of Pregnancy-Associated Cardiomyopathy). Journal of the American College of Cardiology. 2015. Aug 25;66(8):905–14. doi: 10.1016/j.jacc.2015.06.1309.. eng. - DOI - PMC - PubMed