Cardiomyopathy Prevalence and Pregnancy-Related Mortality: United States, 2010 to 2020

Abstract

Background: Cardiomyopathies, particularly peripartum cardiomyopathy (PPCM), significantly contribute to maternal morbidity in the United States.

Objectives: The authors estimated the prevalence and mortality of PPCM and other cardiomyopathies (OCMs) during pregnancy among women aged 15 to 55 years from 2010 to 2020 in the United States using a cross-sectional analysis of multiple data sets.

Methods: We identified PPCM, OCM, and deliveries using International Classification of Diseases and diagnosis related group codes in the National Inpatient Sample. We calculated PPCM and OCM prevalence and adjusted prevalence ratios (aPRs) by select covariates. We identified pregnancy-related deaths from all cardiomyopathies combined and PPCM exclusively from 2015 to 2020 Pregnancy Mortality Surveillance System. We calculated pregnancy-related mortality ratios (PRMR) by select covariates.

Results: The overall PPCM and OCM prevalence were 105.1 (95% CI: 101.8-108.3) and 76.1 (95% CI: 73.6-78.7) cases per 100,000 delivery hospitalizations, respectively. PPCM prevalence increased with advancing maternal age and decreasing neighborhood income and exhibited marked differences among Black and American Indian or Alaska Native women (aPR: 3.58 [95% CI: 3.36-3.82] and aPR: 1.96 [95% CI: 1.57-2.45], respectively). PPCM prevalence was higher among those with chronic hypertension and diabetes (aPR: 12.17 [95% CI: 11.51-12.88] and aPR: 6.25 [95% CI: 5.77-6.78], respectively). The overall cardiomyopathy and PPCM PRMR were 2.1 and 1.0 deaths per 100,000 live births, respectively. PRMR were highest among those aged ≥40 years and among American Indian and Black women (overall cardiomyopathy PRMR: 7.3, 6.0 deaths per 100,000 live births respectively).

Conclusions: Intensifying efforts to address cardiomyopathies and enhance cardiovascular health before, during, and following pregnancy may reduce the burden of maternal morbidity.

Keywords: cardiomyopathy; cardiovascular disease; maternal mortality; peripartum cardiomyopathy; pregnancy.

Graphical abstract

Figure 1

Peripartum Cardiomyopathy and Other Cardiomyopathies’ Prevalence (95% CI) by Year, Ages 15 to 55 Years, National Inpatient Sample, United States, 2010 to 2020 Yearly peripartum cardiomyopathy and other cardiomyopathy prevalence was estimated from National Inpatient Sample data. Other cardiomyopathy prevalence significantly increased (average annual percent change: 4.9% [95% CI: 3.0%-7.1%]) from 2010 to 2020. Peripartum cardiomyopathy prevalence did not statistically change (average annual percent change: 1.3% [95% CI: −1.1% to 4.0%]). OCM = other cardiomyopathy; PPCM = peripartum cardiomyopathy.

Figure 2

Pregnancy-Related Cardiomyopathy Prevalence and Mortality by Region, United States^a,b Prevalence and mortality from pregnancy-related cardiomyopathies were mapped to document geographic differences within the United States. ^aMaps of mortality use regions defined by the U.S. Department of Health and Human Services with data from the Pregnancy Mortality Surveillance System, 2015 to 2019. Maps of prevalence use divisions defined by the U.S. Census Bureau with data from the National Inpatient Sample, 2010 to 2020. ^bRegions shaded gray are suppressed because they have <9 events. OCM = other cardiomyopathy; PPCM = peripartum cardiomyopathy; PRMR = pregnancy-related mortality ratio.

Central Illustration

Peripartum Cardiomyopathy and Other Cardiomyopathies’ Prevalence Present Notable Differences Several populations are at higher risk for peripartum cardiomyopathy and other cardiomyopathies during pregnancy, including older women, Black and AI/AN women, people from lower income neighborhoods, and those with cardiovascular risk factors including hypertension, diabetes, and obesity.