Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
J Matern Fetal Neonatal Med. 2022 May;35(10):1891-1898. doi: 10.1080/14767058.2020.1773784. Epub 2020 Jun 7.
Black women have greater than a three-fold risk of pregnancy-associated death compared to White women; cardiomyopathy is a leading cause of maternal mortality.
This study examined racial disparities in health outcomes among women with peripartum cardiomyopathy.
Retrospective cohort of women with peripartum cardiomyopathy per the National Heart, Lung, and Blood Institute definition from January 2000 to November 2017 from a single referral center. Selected health outcomes among Black and White women were compared; primary outcome was ejection fraction at diagnosis. Secondary outcomes included cardiovascular outcomes, markers of maternal morbidity, resource utilization, and subsequent pregnancy outcomes.
Ninety-five women met inclusion criteria: 48% Black, 52% White. Nearly all peripartum cardiomyopathy diagnoses were postpartum (95.4% Black, 93% White, =.11). Ejection fraction at diagnosis was not different between Black and White women (26.8 ± 12.5 vs. 28.7 ± 9.9, =.41). Though non-significant, fewer Black women had myocardial recovery to EF ≥55% (35 vs. 53%, =.07); however, 11 (24%) of Black women vs. 1 (2%) White woman had an ejection fraction ≤35% at 6-12 months postpartum (<.01). More Black women underwent implantable cardioverter defibrillator placement: = 15 (33%) vs. = 7 (14%), =.03. Eight women (8.4%) died in the study period, not different by race (=.48). Black women had higher rates of healthcare utilization. In the subsequent pregnancy, Black women had a lower initial ejection fraction (40 vs. 55%, =.007) and were less likely to recover postpartum (37.5 vs. 55%, =.02).
Black and White women have similar mean ejection fraction at diagnosis of peripartum cardiomyopathy, but Black women have more severe left ventricular systolic dysfunction leading to worse outcomes, increased resource use, and lower ejection fraction entering the subsequent pregnancy.
与白人女性相比，黑人女性妊娠相关死亡的风险高出三倍以上；心肌病是孕产妇死亡的主要原因。
本研究旨在探讨围产期心肌病患者的健康结局存在种族差异。
这是一项回顾性队列研究，纳入了 2000 年 1 月至 2017 年 11 月期间，根据美国国立心肺血液研究所的定义，在单一转诊中心诊断为围产期心肌病的女性患者。比较了黑人和白人女性的健康结局；主要结局为诊断时的射血分数。次要结局包括心血管结局、孕产妇发病率标志物、资源利用和随后的妊娠结局。
95 名女性符合纳入标准：黑人占 48%，白人占 52%。几乎所有的围产期心肌病诊断都是产后（黑人占 95.4%，白人占 93%，=.11）。黑人女性和白人女性诊断时的射血分数无差异（26.8±12.5 比 28.7±9.9，=.41）。尽管无统计学意义，但黑人女性中心肌恢复至 EF≥55%的比例较低（35%比 53%，=.07）；然而，黑人女性中有 11 名（24%）在产后 6-12 个月时的射血分数≤35%，而白人女性中只有 1 名（2%）（<.01）。更多的黑人女性接受了植入式心脏复律除颤器的植入：=15 名（33%）比=7 名（14%），=.03。在研究期间，有 8 名女性（8.4%）死亡，种族间无差异（=.48）。黑人女性的医疗保健利用率更高。在随后的妊娠中，黑人女性的初始射血分数较低（40 比 55%，=.007），且产后恢复的可能性较低（37.5 比 55%，=.02）。
黑人女性和白人女性围产期心肌病的平均射血分数相似，但黑人女性左心室收缩功能更严重，导致预后更差、资源利用增加，且进入后续妊娠时射血分数更低。
