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Peripartum Cardiomyopathy
Peripartum cardiomyopathy (PPCM), a disorder specific to pregnancy, is one of the most feared complications for pregnant women and their medical care teams. It carries such a heightened risk for recurrence and subsequent morbidity and mortality that it warrants counseling against future conception. However, relatively little is understood about its underlying pathophysiology, risk factors, and early warning signs. This chapter explores the incidence and risk factors, diagnosis, proposed etiologies and pathophysiology, treatment, and prognosis of PPCM.
Incidence and Risk Factors
Owing to the tremendous overlap with other diseases and given that PPCM is a diagnosis of exclusion, its true incidence is unknown. In addition, the highly variable clinical presentation makes it difficult to determine an accurate incidence estimate in resource-poor countries. The World Health Organization (WHO) estimates that between 18 and 333 cases of PPCM occur for every 100,000 live births. The wide variation reflects regional differences, with rates as high as 1 in 50 live births within certain African countries and Haiti. Within the United States, the incidence ranges between 1 in 2066 to 1 in 4025 live births. Racial differences also can account for the relatively wide range of incidence estimates. A US study by Harper and colleagues demonstrated a significantly higher incidence in Black women versus Hispanic and White women. The incidence of PPCM was 9.2 cases per 10, 000 live births among Black women versus 2.34 per 10, 000 live births among White women and 0.32 per 10, 000 live births among Hispanic women. These differences appear to correlate with and can be partly explained by examining the identified risk factors for PPCM ( Table 8.1 ).
Table 8.1
Risk Factors for Peripartum Cardiomyopathy by Evidence Association
| Demonstrated | Proposed | Emerging |
|---|---|---|
| Multifetal gestation (twins) | Smoking | Preeclampsia |
| High gravidity and parity | Chronic hypertension | Genetics |
| Extremes of reproductive age | Malnutrition | Obesity |
| Prolonged tocolysis | Cocaine abuse | |
| African ancestry | ||
| Socioeconomic status |
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