Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, USA.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, CA, USA.
Pregnancy Hypertens. 2023 Dec;34:116-123. doi: 10.1016/j.preghy.2023.11.004. Epub 2023 Nov 9.
To evaluate risk for peripartum cardiomyopathy during delivery and postpartum hospitalizations, and analyze associated trends, risk factors, and clinical outcomes.
The 2010-2020 Nationwide Readmissions Database was used for this retrospective cohort study. Delivery hospitalizations along with postpartum readmissions occurring within five months of delivery discharge were analyzed. Risk factors associated with peripartum cardiomyopathy were analyzed with unadjusted and adjusted logistic regression models with odds ratios as measures of effect. Risk for severe adverse outcomes associated with peripartum cardiomyopathy was analyzed. Trends were analyzed with joinpoint regression.
Of 39,790,772 delivery hospitalizations identified, 9,210 were complicated by a diagnosis of peripartum cardiomyopathy (2.3 per 10,000). Risk for a 5-month readmission with a peripartum cardiomyopathy diagnosis was 4.8 per 10,000. Factors associated with peripartum cardiomyopathy during deliveries included preeclampsia with severe features (OR 18.9, 95 % CI 17.2, 20.7), preeclampsia without severe features (OR 6.9, 95 % CI 6.1, 7.8), multiple gestation (OR 4.7, 95 % CI 4.1, 5.3), chronic hypertension (OR 10.1, 95 % CI 8.9, 11.3), and older maternal age. Associations were attenuated but retained significance in adjusted models. Similar estimates were found when evaluating associations with postpartum readmissions. Peripartum cardiomyopathy readmissions were associated with 10 % of overall postpartum deaths, 21 % of cardiac arrest/ventricular fibrillation diagnoses, 18 % of extracorporeal membrane oxygenation cases, and 40 % of cardiogenic shock. In joinpoint analysis, peripartum cardiomyopathy increased significantly during delivery hospitalizations (average annual percent change [AAPC] 2.2 %, 95 % CI 1.0 %, 3.4 %) but not postpartum readmissions (AAPC 0.0 %, 95 % CI -1.6 %, 1.6 %).
Risk for peripartum cardiomyopathy increased during delivery hospitalizations over the study period. Obstetric conditions such as preeclampsia and chronic medical conditions that are increasing in prevalence in the obstetric population were associated with the highest odds of peripartum cardiomyopathy.
评估分娩和产后住院期间围产期心肌病的风险，并分析相关趋势、风险因素和临床结局。
本回顾性队列研究使用了 2010-2020 年全国再入院数据库。分析了分娩住院和产后出院后五个月内的再入院情况。使用未经调整和调整后的逻辑回归模型分析与围产期心肌病相关的风险因素，并用优势比作为效应的衡量指标。分析了与围产期心肌病相关的严重不良结局的风险。使用连接点回归分析趋势。
在确定的 39790720 例分娩住院中，有 9210 例诊断为围产期心肌病（每 10000 例中有 2.3 例）。5 个月内因围产期心肌病再入院的风险为每 10000 例 4.8 例。与分娩期间围产期心肌病相关的因素包括重度子痫前期（OR 18.9，95%CI 17.2，20.7）、无重度子痫前期（OR 6.9，95%CI 6.1，7.8）、多胎妊娠（OR 4.7，95%CI 4.1，5.3）、慢性高血压（OR 10.1，95%CI 8.9，11.3）和产妇年龄较大。在调整模型中，这些关联虽然减弱但仍具有统计学意义。在评估与产后再入院的关联时，也得出了类似的估计。围产期心肌病再入院与总产后死亡的 10%、心脏骤停/心室颤动诊断的 21%、体外膜肺氧合病例的 18%和心源性休克的 40%相关。在连接点分析中，围产期心肌病在分娩住院期间显著增加（平均年变化百分比[APC]为 2.2%，95%CI 1.0%，3.4%），但产后再入院没有增加（APC 0.0%，95%CI-1.6%，1.6%）。
在研究期间，分娩住院期间围产期心肌病的风险增加。与围产期心肌病相关的风险最高的是子痫前期等产科情况和在产科人群中患病率不断上升的慢性疾病。
