Peripartum cardiomyopathy: An epidemiologic study of early and late presentations

Abstract

Objective: Peripartum cardiomyopathy (PPCM) can present during pregnancy and up to months post-delivery. Most large-scale epidemiologic studies have reported on cases occurring during pregnancy or the first few days postpartum (termPPCM). Limited information is available on PPCM in the later postpartum period (latePPCM). We studied the incidence, predictors, and hospital outcome of peripartum cardiomyopathy (PPCM) in the prepartum and immediate post delivery period versus up to 3 months post-delivery.

Methods: We performed a secondary analysis of the 2013 Nationwide Readmissions Database, and compared the incidence, patient characteristics and in-hospital outcomes of PPCM during the peripartum and three-month postpartum period. All women with a discharge diagnosis of PPCM during a hospitalization for childbirth were included in the termPPCM group and those re-hospitalized within 3 month post-delivery with a new diagnosis of PPCM comprised the latePPCM group.

Results: There were 568 cases of PPCM, indicating an incidence of 1 per 2187 deliveries. Two thirds of those were latePPCM, and 75% of latePPCM cases occurred within 10 days of discharge. LatePPCM incidence was 1 per 208 deliveries in the highest risk group (age > 35, gestation diabetes and preeclampsia). Patients with termPPCM were more likely to be co-diagnosed with preeclampsia, to be anemic, and to be delivered by C-section.

Conclusions: Most cases of PPCM were diagnosed during a readmission, rather than during pregnancy or childbirth-related index hospitalization. It may be possible to identify latePPCM cases by pre-discharge screening in high risk women and institute early management to potentially decrease morbidity/mortality.

Keywords: Nationwide Readmissions Database; Peripartum cardiomyopathy; Preeclampsia; Pregnancy.