Association Between Diabetes During Pregnancy and Peripartum Cardiomyopathy: A Population-Level Analysis of 309,825 Women

Abstract

BackgroundPeripartum cardiomyopathy (PPCM) is a form of heart failure associated with pregnancy. The objectives of our study were to determine the incidence and outcomes (maternal and neonatal) of PPCM and its association with diabetes mellitus (DM) in a contemporary population-based cohort. MethodsThe cohort consisted of 309,825 women with a birth of at least 1 live newborn between January 01, 2005 and September 30, 2014, resulting in 469,150 birth events and 477,089 live newborns. A modified PPCM definition was used, allowing from 32 weeks' gestation and up to 6 months postpartum. Women were categorized according to DM status. ResultsA total of 194 PPCM birth events were identified, for an incidence rate of 1/2418 births. Women with PPCM were older, often primiparous, and more likely to have multiple gestations, pre-existing DM, and hypertensive disorders of pregnancy. Although the overall numbers were low, the incidence of PPCM was higher in pregnancies in women with pre-existing DM (1/613 birth events) and gestational DM (1/1751 birth events) vs those with neither (1/2550 birth events). Over a mean follow-up of 3.9 years, the mortality rate was higher in women affected by PPCM than in those who were not, with few deaths overall. Neonatal death was uncommon in the entire cohort but was numerically greater in the PPCM group. ConclusionsThe incidence of PPCM in Alberta, Canada was approximately 1/2400 births and was modulated by the presence of DM in pregnancy. The relationship between DM status and PPCM may be confounded by other vascular risk factors, including hypertensive disorders of pregnancy. There were few maternal or neonatal deaths in the overall cohort, but they were numerically higher in the PPCM group.