Pre-pregnancy Obesity and the Risk of Peripartum Cardiomyopathy

Abstract Objective The aim of this study is to evaluate the contribution of pre-pregnancy obesity and overweight to peripartum cardiomyopathy. Study Design This population-based study used linked birth record and maternal hospital discharge data from live births in California during 2007 to 2012 (n = 2,548,380). All women who had a diagnosis of peripartum cardiomyopathy during the childbirth hospitalization or who were diagnosed with peripartum cardiomyopathy during a postpartum hospital readmission within 5 months of birth were identified as cases. Pre-pregnancy body mass index (BMI, kg/m2) was classified as normal weight (18.5–24.9), overweight (25.0–29.9), obesity class 1 (30.0–34.9), obesity class 2 (35.0–39.9), and obesity class 3 (≥40). Because of small numbers, we excluded women with underweight BMI, and in some analyses, we combined obesity classes into one group. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) expressing associations between BMI and peripartum cardiomyopathy, adjusted for maternal age, race/ethnicity, education, health care payer, parity, plurality, and comorbidities. Results The overall prevalence of peripartum cardiomyopathy during hospital admissions was 1.3 per 10,000 live births (n = 320). Unadjusted ORs were 1.32 (95% CI: 1.01–1.74) for women with overweight BMI and 2.03 (95% CI: 1.57–2.62) for women with obesity, compared with women with normal pre-pregnancy BMI. Adjusted ORs were 1.26 (95% CI: 0.95–1.66) for overweight women and 1.38 (95% CI: 1.04–1.84) for women with obesity. The ORs suggested a dose–response relationship with increasing levels of obesity, but the 95% CIs for the specific classes of obesity included 1.00. Conclusion Pre-pregnancy obesity was associated with an increased risk of peripartum cardiomyopathy. These findings underscore the importance of BMI during pregnancy. There is a need to recognize the increased risk of peripartum cardiomyopathy in women with high BMI, especially in the late postpartum period. Key Points Pre-pregnancy obesity affects maternal health. Effects may extend to peripartum cardiomyopathy. The risk includes peripartum cardiomyopathy that emerges postpartum.

[1]  L. Pilote,et al.  Peripartum cardiomyopathy with co-incident preeclampsia: A cohort study of clinical risk factors and outcomes among commercially insured women. , 2019, Pregnancy hypertension.

[2]  W. Callaghan,et al.  Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017 , 2019, MMWR. Morbidity and mortality weekly report.

[3]  H. Bundgaard,et al.  Hypertensive disorders of pregnancy and peripartum cardiomyopathy: A nationwide cohort study , 2019, PloS one.

[4]  S. Carmichael,et al.  The contribution of maternal characteristics and cesarean delivery to an increasing trend of severe maternal morbidity , 2019, BMC Pregnancy and Childbirth.

[5]  L. Blauwet,et al.  Peripartum Cardiomyopathy and Preeclampsia: Overlapping Diseases of Pregnancy , 2018, Current Hypertension Reports.

[6]  Z. Arany,et al.  Peripartum cardiomyopathy: An epidemiologic study of early and late presentations. , 2018, Pregnancy hypertension.

[7]  K. Sliwa,et al.  Long‐term prognosis, subsequent pregnancy, contraception and overall management of peripartum cardiomyopathy: practical guidance paper from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy , 2018, European journal of heart failure.

[8]  Nicholas P. Deputy,et al.  Prevalence and Trends in Prepregnancy Normal Weight — 48 States, New York City, and District of Columbia, 2011–2015 , 2018, MMWR. Morbidity and mortality weekly report.

[9]  B. Abrams,et al.  The accuracy of self‐reported pregnancy‐related weight: a systematic review , 2017, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[10]  Christine H Morton,et al.  Pregnancy-related cardiovascular deaths in California: beyond peripartum cardiomyopathy. , 2015, American journal of obstetrics and gynecology.

[11]  H. Minakami,et al.  Gestational Weight Gain and Peripartum Cardiomyopathy in a Twin Pregnancy , 2015, Case reports in obstetrics and gynecology.

[12]  A. Pandey,et al.  Epidemiology and outcomes of peripartum cardiomyopathy in the United States: findings from the Nationwide Inpatient Sample , 2014, Journal of cardiovascular medicine.

[13]  H. Minakami,et al.  Peripartum cardiomyopathy in a woman with preeclampsia with twin pregnancy , 2014, BMJ Case Reports.

[14]  D. Kolte,et al.  Temporal Trends in Incidence and Outcomes of Peripartum Cardiomyopathy in the United States: A Nationwide Population‐Based Study , 2014, Journal of the American Heart Association.

[15]  S. Redline,et al.  Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States, 1998-2009. , 2014, Sleep.

[16]  Beeresha Puttegowda,et al.  Acute myocardial infarction following honeybee sting , 2014, BMJ Case Reports.

[17]  M. P. van den Berg,et al.  Pregnancy, cardiomyopathies, and genetics. , 2014, Cardiovascular research.

[18]  Hude Quan,et al.  Coding of obesity in administrative hospital discharge abstract data: accuracy and impact for future research studies , 2014, BMC Health Services Research.

[19]  I. Goldenberg,et al.  Peripartum cardiomyopathy – risk factors, characteristics and long-term follow-up , 2014, Journal of perinatal medicine.

[20]  H. Minakami,et al.  Extraordinary weight gain: initial finding in a patient with peripartum cardiomyopathy , 2013 .

[21]  N. Bello,et al.  The relationship between pre-eclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis. , 2013, Journal of the American College of Cardiology.

[22]  J. Lindenfeld,et al.  Characteristics, adverse events, and racial differences among delivering mothers with peripartum cardiomyopathy. , 2013, JACC. Heart failure.

[23]  C. Berg,et al.  Peripartum Cardiomyopathy: Population-Based Birth Prevalence and 7-Year Mortality , 2012, Obstetrics and gynecology.

[24]  T. Vittorio,et al.  A perspective on obesity cardiomyopathy. , 2012, Obesity research & clinical practice.

[25]  Cathleen K. Yoshida,et al.  Epidemiology of Peripartum Cardiomyopathy: Incidence, Predictors, and Outcomes , 2011, Obstetrics and gynecology.

[26]  U. Elkayam.  Clinical characteristics of peripartum cardiomyopathy in the United States: diagnosis, prognosis, and management. , 2011, Journal of the American College of Cardiology.

[27]  K. Sliwa,et al.  Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy , 2010, European journal of heart failure.

[28]  W. Callaghan,et al.  Cardiomyopathy and Other Myocardial Disorders Among Hospitalizations for Pregnancy in the United States: 2004–2006 , 2010, Obstetrics and gynecology.

[29]  C. D. Dela Cruz,et al.  Role of obesity in cardiomyopathy and pulmonary hypertension. , 2009, Clinics in chest medicine.

[30]  H. Quan,et al.  Assessing validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions in a unique dually coded database. , 2008, Health services research.

[31]  T. Marwick,et al.  Obesity cardiomyopathy: diagnosis and therapeutic implications , 2007, Nature Clinical Practice Cardiovascular Medicine.

[32]  W. Callaghan,et al.  The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data. , 2005, American journal of obstetrics and gynecology.

[33]  U. Elkayam,et al.  Pregnancy-Associated Cardiomyopathy: Clinical Characteristics and a Comparison Between Early and Late Presentation , 2005, Circulation.

[34]  M. Alpert.  Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. , 2001, The American journal of the medical sciences.

[35]  J. Hsia,et al.  Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. , 2000, JAMA.

[36]  C. S. Brown,et al.  Peripartum cardiomyopathy: a comprehensive review. , 1998, American journal of obstetrics and gynecology.

[37]  H. Neufeld,et al.  [Peripartum cardiomyopathy (PPCM)]. , 1979, Harefuah.

[38]  M. Gatzoulis,et al.  Management of cardiomyopathies in pregnancy , 2016 .

[39]  H. Minakami,et al.  Gestational Weight Gain in a Woman with Peripartum Cardiomyopathy , 2016 .

[40]  J. V. Hook,et al.  Peripartum Cardiomyopathy and Pulmonary Edema , 2011 .

[41]  T. Marwick,et al.  Obesity cardiomyopathy: pathogenesis and pathophysiology , 2007, Nature Clinical Practice Cardiovascular Medicine.

[42]  B. Sibai,et al.  Peripartum cardiomyopathy: an ominous diagnosis. , 1997, American journal of obstetrics and gynecology.

[43]  S. Jayalakshmi,et al.  Peripartum cardiomyopathy. , 1980, Journal of the Indian Medical Association.