Characteristics and In-Hospital Outcomes of Peripartum Cardiomyopathy Diagnosed During Delivery in the United States From the Nationwide Inpatient Sample (NIS) Database

• Established risk factors for peripartum cardiomyopathy (PPCM) include advanced maternal age, African-American race, hypertensive disorders of pregnancy, and multiple-gestation pregnancies.
• Hypertensive disorders of pregnancy and anemia are associated with PPCM in whites, African Americans, and Hispanics.
• Anemia, asthma, smoking, and thyroid disorders are recently identified risk factors for PPCM.
• Physicians should maintain a high index of suspicion for the diagnosis of PPCM among delivering mothers with known risk factors and symptoms of heart failure.

BackgroundPeripartum cardiomyopathy (PPCM) is associated with advanced maternal age, African-American race, hypertensive disorders of pregnancy, and multiple-gestation pregnancies. Less is known regarding racial differences in risk factors and predictors of adverse in-hospital outcomes.Methods and ResultsA total of 1,337 women with PPCM were identified with the use of the Nationwide Inpatient Sample (2004–2011). Clinical profiles and maternal outcomes in delivering mothers with and without PPCM were compared and stratified by race. In multivariate analysis, established risk factors for PPCM were confirmed. Anemia (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.6–2.5; P < .0001), asthma (OR 2.2, 95% CI 1.5–3.2; P = .0002), smoking (OR 33.6, 95% CI 9.3–159.4; P < .0001), and thyroid disease (OR 5.9; 95% CI 1.5–21.3; P = .01) were associated with PPCM. Risk factors significant in whites, African Americans, and Hispanics were hypertension during pregnancy and anemia. Patients with PPCM had higher rates of in-hospital adverse outcomes (P < .0001), but no differences in race or comorbidities predicted adverse events.ConclusionsHypertensive disorders during pregnancy and anemia were associated with PPCM in whites, African Americans, and Hispanics, providing further evidence that vascular stress may play a role in the pathogenesis of PPCM. Thyroid disorders may represent a novel risk factor for PPCM.