Peripartum cardiomyopathy is independently associated with pre-existing cardiovascular disease and smoking, with Loss of Racial Disparities After Multivariate Adjustment

BackgroundPeripartum cardiomyopathy (PPCM) is a life-threatening condition. Despite rising incidence, outcomes have not improved. This study evaluated national inpatient trends, disparities, and independent risk factors for PPCM. MethodsUsing the National Inpatient Sample (2016-2020), we analyzed adults ([≥]18 years) hospitalized between 10 and 42 weeks of gestation. Among 18,844,715 patients, 4,475 had PPCM. We performed uni- and multivariate logistic regression analysis of risk factors for PCCM, adjusting for age, race, comorbidities, hospital characteristics, and socioeconomic factors. ResultsPPCM was associated with higher maternal mortality (1.01% vs 0.01%; OR 164.41, 95% CI 84.17-321.12). Univariate analysis showed a higher association with preeclampsia, gestational diabetes, gestational hypertension, preexisting hypertension, coronary artery disease (CAD), chronic kidney disease, systemic lupus erythematosus, type 2 diabetes, obesity and smoking. PPCM was more common in Black and Native American patients, those younger than 30, and individuals from lower-income households. However, after adjustment, significant associations only persisted for preeclampsia, gestational hypertension, preexisting hypertension, CAD, and smoking. CAD showed the strongest association in both univariate (OR 125.86, 95% CI 89.17-177.66) and multivariate models (OR 3.29, 95% CI 2.19-4.95). Racial disparities were no longer significant after adjustment. ConclusionPPCM is associated with higher mortality. It is independently associated with preexisting cardiovascular risk factors. Apparent racial disparities primarily reflect comorbidities and social determinants and are not independent risk.