Association of cardiomyopathy with adverse cardiac events in pregnant women at the time of delivery

Abstract

Objectives: The aim of this study was to determine the predictors of adverse events in pregnant women with cardiomyopathy (CDM) and CDM subtypes at the time of delivery.

Background: Investigation of patients' characteristics and outcomes in women with CDM at the time of delivery has been limited.

Methods: The Healthcare Cost and Utilization Project's National Inpatient Sample was screened for hospital admissions for delivery in pregnant women with CDM from 2006 to 2010. Clinical characteristics and maternal outcomes were identified in women with and without CDM and in CDM subtypes. The primary outcome of interest was major adverse clinical events (MACE), a composite of in-hospital death, acute myocardial infarction, heart failure, arrhythmia, cerebrovascular event, or embolic event.

Results: Our study population comprised 2,078 patients with CDM and 4,438,439 patients without CDM. Of those with CDM, 52 (2.5%) were hypertrophic, 1,039 (50.0%) were peripartum, and 987 (47.5%) were classified as other. Women with CDM were older, white, and insured by Medicaid. MACE rates were significantly higher in women with peripartum CDM (46%), compared with hypertrophic CDM (23%) and all others (39%) (p < 0.001). In multivariable analysis, the presence of peripartum cardiomyopathy (odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.1 to 4.6), valvular disease (OR: 2.11; 95% CI: 1.6 to 2.9), and eclampsia (OR: 5.0; 95% CI: 1.6 to 1.9) was independently associated with MACE.

Conclusions: Presence of CDM is independently predictive of MACE during hospitalization for delivery. Patients with peripartum CDM had the highest likelihood of MACE compared with other CDM subtypes.

Keywords: cardiomyopathy; delivery; hypertrophic cardiomyopathy; maternal outcomes; peripartum cardiomyopathy; pregnancy.