262084 Peripartum cardiomyopathy and obesity among maternal deaths in California

Wednesday, October 31, 2012

Christy McCain, MPH , Public Health Institute, Santa Cruz, CA
Sue Holtby, MPH , Public Health Institute, Santa Cruz, CA
Elizabeth Lawton, MHS , California Department of Public Health, Maternal, Child and Adolescent Heatlh Division, Sacramento, CA
Connie Mitchell, MD, MPH , California Department of Public Health, Maternal Child and Adolescent Health Division, Sacramento, CA
Elliott Main, MD , OB/GYN, California Pacific Medical Center, San Francisco, CA
Christine Morton, PhD , Stanford University, California Maternal Quality Care Collaborative, Palo Alto, CA
Background/Methods: The California Pregnancy-Associated Mortality Review (CA-PAMR) is a public health project funded from Title V MCAH Block Grants to review pregnancy-related deaths in order to identify causes of death, contributing factors, and opportunities for improvement. Based on review of 145 cases from 2002-2004, peripartum cardiomyopathy is now the second leading cause of pregnancy-related death in California. CA-PAMR data was used to examine the characteristics of women who died from cardiomyopathy.

Results: Peripartum cardiomyopathy accounted for 19 (13%) of the 145 deaths. Among these, 58% were obese (BMI≥30) and 89% were overweight or obese (BMI≥25). Women who died of cardiomyopathy were significantly more likely to be obese than those who died from other causes combined (58% vs. 21% respectively, p<.05) and to have had excessive gestational weight gain. African-American women were almost four times as likely as all other racial/ethnic groups combined to die from cardiomyopathy (27% vs. 9% respectively, p<.05) and were more likely than other groups to be obese (p<.01). Cardiomyopathy deaths occurred later than other maternal deaths, with a mean of 103 days postpartum versus 13 days respectively (p<.01). The leading contributing factors identified were: pre-existing medical conditions (63%); delay in diagnosis or treatment (47%); lack of continuity of care (47%) and obesity (47%). There was a good/strong chance to have altered the outcome in 26% of the cardiomyopathy deaths.

Conclusion: Peripartum cardiomyopathy is now a leading cause of pregnancy-related death. Overweight and obese women and African-American women are at higher risk of maternal death from cardiomyopathy.

Learning Areas:
Chronic disease management and prevention

Learning Objectives:
1. Describe the association between peripartum cardiomyopathy and obesity, based on the findings from the California Pregnancy-Associated Mortality Review. 2.Describe discrepancies between cardiomyopathy deaths and other causes of death. 3.Describe the degree of preventability among the cardiomyopathy deaths and the leading factors that contributed to the deaths.

Keywords: Obesity, Heart Disease

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked in maternal and reproductive health research for over 10 years. I manage the data collection and analysis for the Pregnancy-Associated Mortality Review.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.