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Am J Perinatol 2021; 38(12): 1289-1296
DOI: 10.1055/s-0040-1712451
Original Article

Pre-pregnancy Obesity and the Risk of Peripartum Cardiomyopathy

Seo-Ho Cho
1   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California
,
Stephanie A. Leonard
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Audrey Lyndon
3   Rory Meyers College of Nursing, New York University, New York, New York
,
Elliott K. Main
4   California Maternal Quality Care Collaborative, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Barbara Abrams
5   Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, California
,
Afshan B. Hameed
6   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine School of Medicine, Irvine, California
7   Division of Cardiology, Department of Medicine, University of California Irvine School of Medicine, Irvine, California
,
Suzan L. Carmichael
8   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
9   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
› Author Affiliations Funding This project was supported by grant R01NR017020 from the National Institute of Nursing Research (awarded to S.L.C.), postdoctoral fellowship F32HD091945 from the Eunice Kennedy Shriver National Institute of Child Health and Development ( awarded to S.A.L.), and Stanford Maternal and Child Health Research Institute. The funding sources had no involvement in the conduct of research or preparation of this article.
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Abstract

Objective The aim of this study is to evaluate the contribution of pre-pregnancy obesity and overweight to peripartum cardiomyopathy.

Study Design This population-based study used linked birth record and maternal hospital discharge data from live births in California during 2007 to 2012 (n = 2,548,380). All women who had a diagnosis of peripartum cardiomyopathy during the childbirth hospitalization or who were diagnosed with peripartum cardiomyopathy during a postpartum hospital readmission within 5 months of birth were identified as cases. Pre-pregnancy body mass index (BMI, kg/m2) was classified as normal weight (18.5–24.9), overweight (25.0–29.9), obesity class 1 (30.0–34.9), obesity class 2 (35.0–39.9), and obesity class 3 (≥40). Because of small numbers, we excluded women with underweight BMI, and in some analyses, we combined obesity classes into one group. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) expressing associations between BMI and peripartum cardiomyopathy, adjusted for maternal age, race/ethnicity, education, health care payer, parity, plurality, and comorbidities.

Results The overall prevalence of peripartum cardiomyopathy during hospital admissions was 1.3 per 10,000 live births (n = 320). Unadjusted ORs were 1.32 (95% CI: 1.01–1.74) for women with overweight BMI and 2.03 (95% CI: 1.57–2.62) for women with obesity, compared with women with normal pre-pregnancy BMI. Adjusted ORs were 1.26 (95% CI: 0.95–1.66) for overweight women and 1.38 (95% CI: 1.04–1.84) for women with obesity. The ORs suggested a dose–response relationship with increasing levels of obesity, but the 95% CIs for the specific classes of obesity included 1.00.

Conclusion Pre-pregnancy obesity was associated with an increased risk of peripartum cardiomyopathy. These findings underscore the importance of BMI during pregnancy. There is a need to recognize the increased risk of peripartum cardiomyopathy in women with high BMI, especially in the late postpartum period.

Key Points

  • Pre-pregnancy obesity affects maternal health.

  • Effects may extend to peripartum cardiomyopathy.

  • The risk includes peripartum cardiomyopathy that emerges postpartum.

Keywords

body mass index - heart failure - hypertensive disorder - maternal health - pregnancy complication

Supplementary Material



Publication History

Received: 14 November 2019

Accepted: 15 April 2020

Article published online:
08 June 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

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