Introduction:
Characterized by significant left ventricular (LV) dysfunction and clinical heart failure (HF), peripartum cardiomyopathy (PPCM) has an incidence of approximately 1/2200 live births (0.04%). Prior studies estimate that approximately 25% of those with recovered LV function will have recurrent clinical PPCM during subsequent pregnancies, compared to 50% of those without recovered LV function. Specific predictors of recurrent PPCM have not been studied in cohorts with large numbers.
Methods:
From 2005-2011, we identified 1,872,227 pregnancies by International Classification of Diseases, 9th Revision (ICD-9) codes in the California Healthcare Cost and Utilization Project (HCUP) database, which captures over 95% of the California hospitalized population. Excluding 15,765 women with prior cardiovascular disease (myocardial infarction, coronary artery disease, stroke, HF, valve disease, or congenital heart disease), yielded n=1,856,462 women. Among women without prior cardiovascular disease, we identified index and subsequent pregnancies with PPCM to determine episodes of recurrent PPCM. We considered the following potential predictors of PPCM recurrence in both univariate and age-adjusted logistic regression models: age, race, hypertension, diabetes, smoking, obesity, chronic kidney disease, family history, pre-eclampsia, ectopic pregnancy, income, and insurance status.
Results:
In HCUP, n=783 women had pregnancies complicated by PPCM (mean age=30.8 years). Among these women, n=133 had a subsequent pregnancy (17%; mean age=28.1 years), with a mean follow-up of 4.34 years (±1.71 years). In this group of 133 subsequent pregnancies, n=14 (10.5%) were complicated by recurrent PPCM, with a mean time-to-event of 2.2 years (±1.89 years). Among the risk factors studied, the only univariate predictor of recurrent PPCM was grand multiparity, defined as ≥ 5 previous deliveries (odds ratio: 22; 95% confidence interval 4.43-118.22). The other predictors we studied were not significantly associated with recurrent PPCM in either univariate or multivariable models.
Conclusion:
In a large population database in California with 783 cases of PPCM over a 6-year period, 17% of women had a subsequent pregnancy, of which 10.5% had recurrent PPCM. In age-adjusted logistic regression models, grand multiparity was the only statistically significant predictor of recurrent PPCM.
Are infants born to high-risk patients with grand multiparity at increased risk of adverse outcomes?
