Racial differences in obstetric complications associated with peripartum cardiomyopathy and time to presentation

Abstract Background Peripartum cardiomyopathy (PPCM) is a life-threatening condition with a global incidence of 1 in 2000 births. PPCM has a higher morbidity and mortality in African American (AA) populations, and a worse prognosis associated with delayed presentation. Previous studies suggest that various obstetric complications are associated with an increased risk for developing PPCM. Recently, we identified additional obstetric complications including blood transfusion and premature labor were associated with an increased risk of developing PPCM. However, the relationship between these presentations in respect to race and time to presentation is not well understood. Purpose This study aims to use large cohort study data to characterize racial differences in obstetric complications and their association with time to presentation of PPCM. Methods Public discharge data which included hospital readmission data were obtained from the Agency of Healthcare Research and Quality for the states of Arizona (2003-2007), Florida (2004-2013), and Washington (2003-2012). Hospitalizations reporting a delivery were identified using ICD-9 CM codes (V27.xx). Patient, pregnancy, and obstetric characteristics were determined using ICD-9 CM codes. The primary outcome was a diagnosis of PPCM defined as PPCM coded at any time in the peripartum period within 150 days postpartum, post-delivery presentation was defined as PPCM coded after discharge within this same peripartum period. Patient characteristics were stratified by white, AA, Hispanic. Chi-square test was used for categorical variables and Student’s t-test for continuous variables. Associations were determined using logistic regression. Results In total 3,365,946 delivering mothers were identified. 928 mothers were diagnosed with PPCM, 253 of which were rehospitalized after discharge for PPCM (27.2%). AA race had an increased risk of presenting with PPCM postpartum (95% CI 2.66-3.41, p 0.001). Previously identified risk factors for PPCM such as AA race, gestational diabetes mellitus (GDM), anemia, hypertensive disorders of pregnancy, and advanced maternal age (AMA), were significantly increased in our PPCM cohort (p0.001 for all). Notably, post-delivery PPCM hospitalization had higher rates of AMA, GDM, hypertensive disorders of pregnancy, and RBC transfusion (p 0.001 for all). When further stratifying for race, white and AA patients had a significantly higher risk of post-partum hospitalization for PPCM after transfusion in comparison to Hispanic patients. AA patients were less likely to present with PPCM postpartum following premature labor and C-section, although more likely to present with PPCM postpartum with hypertensive disorders of pregnancy in comparison to their white counterparts. Conclusion The risk profile of obstetric complications in PPCM varies by race and may differentially influence time to presentation.Overall post-delivery PPCM Forest Plot Black post-delivery PPCM Forest Plot