title: Characteristics and In-Hospital Outcomes of Peripartum Cardiomyopathy Diagnosed During Delivery in the United States From the Nationwide Inpatient Sample (NIS) Database.
abstract: BACKGROUND
  Peripartum 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  Hypertensive 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.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan.
authors.forename: Majed
authors.initials: M
authors.lastname: Afana
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: David
authors.initials: D
authors.lastname: Kao
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jackson
authors.affiliation: VA Eastern Colorado Health Care System, Colorado Cardiovascular Outcomes Research Consortium, University of Colorado School of Medicine, Denver, Colorado.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: w3r Consulting, Detroit, Michigan.
authors.forename: David
authors.initials: D
authors.lastname: Childers
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan. Electronic address: davismb@med.umich.edu.
authors.forename: Melinda B
authors.initials: MB
authors.lastname: Davis
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology*; D016208:Databases, Factual; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D006801:Humans; D058725:Peripartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology*; D011644:Puerperal Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Pregnancy; heart failure; racial differences; risk factors