Racial Disparities in U.S. Peripartum Cardiomyopathy: Systematic Review and Meta-Analysis of Risk Factors and Outcomes

TL;DR

Black women in the U.S. with peripartum cardiomyopathy face higher mortality and lower heart recovery rates compared to White women, despite modest differences in risk factors.

Contribution

Quantifies racial disparities in PPCM outcomes and risk factors in U.S. women using a systematic review and meta-analysis.

Findings

Black women had higher mortality (8% vs 2%) and lower ejection fraction recovery (40% vs 63%) compared to White women.

Black women had higher prevalence of diabetes (14% vs 5%) and public payer use (72% vs 30%) compared to White women.

At presentation, Black women had lower mean left ventricular ejection fraction (26% vs 29%).

Abstract

Peripartum cardiomyopathy (PPCM) is a leading cause of heart failure in pregnancy and contributes significantly to maternal morbidity and mortality. Black women are disproportionately affected and experience worse outcomes compared with other groups.

This study aimed to quantify differences in risk factors and outcomes between Black and White women in the United States diagnosed with PPCM.

We conducted a systematic review and meta-analysis of observational studies published after 2002 including U.S. women with PPCM and race-stratified risk factors and outcomes. Investigated outcomes included mortality, major adverse cardiac events, and recovery of left ventricular ejection fraction. Random-effects meta-analysis estimated the pooled prevalence of risk factors and outcomes. Logistic regression, forest plots, and I2 statistics were utilized for analysis.

Compared with controls, cases had higher rates of obesity, preeclampsia, hypertension, diabetes, multiple gestations, and tobacco use. Compared to White cases, Black cases had higher prevalence of diabetes (14% vs 5%; P = 0.027) and utilization of public payer (72% vs 30%; P < 0.001). At presentation, mean left ventricular ejection fraction was 26% in Black women and 29% in White women. White women experienced higher rates of recovery in ejection fraction (63% vs 40%; P < 0.0001). Mortality rates were higher among Black women (8% vs 2%; P = 0.013).

Black women with PPCM experienced lower recovery and higher mortality rates compared with White women. With the exception of a significant difference in payer status, modest differences in previously identified risk factors were observed between racial groups to account for worse outcomes (Disparities in risk factors and outcomes between Black and White US women with peripartum cardiomyopathy: A systematic review and meta-analysis; CRD42023439228).

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