DALLAS, Feb. 25—New research published today in the Journal of the American Heart Association reveals a concerning disparity: Black mothers and those in under-resourced communities face a significantly elevated risk of developing peripartum cardiomyopathy, a life-threatening form of heart failure, during late pregnancy or in the months following delivery. The study, featured in a Go Red for Women spotlight issue, analyzed over 7 million births in California and underscores the urgent need for improved maternal healthcare access and awareness. This alarming trend highlights the critical need for targeted interventions and systemic changes to address health inequities.

The Go Red for Women initiative, launched more than two decades ago, aims to dispel myths and raise awareness about cardiovascular disease, the leading cause of death for women. This new research highlights a critical area where disparities persist, even after accounting for socioeconomic factors and pre-existing conditions. The initiative continues to advocate for research and resources to combat heart disease in women, emphasizing the importance of early detection and prevention.

Jacquelyn Y. Taylor, Ph.D., FAHA, associate editor of the Journal of the American Heart Association, emphasized the significance of the findings. The stark disparity identified in this study is deeply concerning but not entirely surprising, Taylor saeid. Racial disparities in maternal health outcomes are well-documented, frequently enough influenced by systemic factors such as health care access, socioeconomic conditions and other social determinants of health. This study highlights that even after adjusting for socioeconomic status and high blood pressure, the risk for Black mothers remains significantly elevated. Taylor was not involved in the research itself.

Peripartum cardiomyopathy, while rare, has become increasingly frequent and deadly in recent decades. Curisa M. Tucker, Ph.D., R.N.,assistant professor of nursing science at the University of South Carolina,College of Nursing in Columbia,and lead study author,explained the severity of the condition. Peripartum cardiomyopathy, though rare, is a serious condition that doesn’t affect all mothers equally, Tucker said. Black mothers and mothers in underserved communities face the highest risks,pointing to deep-rooted inequities in health care and living conditions. This underscores the urgent need to address the underlying social and economic factors contributing to these disparities.

Several factors can contribute to the progress of peripartum cardiomyopathy, including having multiple pregnancies, being over 35 years old, and having pre-pregnancy high blood pressure. Though,sociodemographic factors also play a crucial role. These factors, combined with systemic inequities, create a perfect storm of risk for Black mothers and those in underserved communities.

Tucker elaborated on the challenges faced by mothers in underserved communities.Mothers in underserved or rural neighborhoods may face meaningful barriers to accessing prenatal and postpartum care, including fewer nearby health care facilities, transportation challenges and long wait times, all of which can delay diagnosis and treatment of the condition, she said. Environmental stressors, such as high levels of pollution, noise or unsafe living conditions, can contribute to chronic stress, a known factor that negatively impacts cardiovascular health, and may increase susceptibility to peripartum cardiomyopathy. these environmental and socioeconomic factors exacerbate the risk for already vulnerable populations.

The study analyzed 15 years of California hospital discharge records,encompassing over 7 million births,to determine if chronic high blood pressure or a lack of neighborhood resources could explain the higher risk among non-Hispanic Black women. The extensive dataset provided a thorough view of maternal health outcomes across diverse communities in California.

Key Findings from the Analysis:

• Mothers living in neighborhoods with fewer resources had a higher risk of peripartum cardiomyopathy, with odds increasing by 20% to 70%.This highlights the significant impact of environmental and socioeconomic factors on maternal health.
• Without adjusting for any other factors,non-Hispanic Black women were 3.5 times as likely to develop peripartum cardiomyopathy as non-Hispanic white women. This stark disparity underscores the urgent need for targeted interventions.
• After adjusting for neighborhood and other factors, non-Hispanic Black women were still 3.4 times as likely to develop peripartum cardiomyopathy as non-Hispanic white women. This indicates that factors beyond socioeconomic status contribute to the increased risk.
• After adjusting for the contribution of chronic high blood pressure and other factors, non-Hispanic Black women were still 3.1 times as likely to develop peripartum cardiomyopathy as non-Hispanic white women.This suggests that underlying systemic issues play a significant role.

Tucker emphasized that the elevated risk persists even after accounting for numerous factors. The elevated risk for Black mothers persists beyond the influence of multiple measurable factors, suggesting that other underlying contributors — such as systemic racism, disparities in access to health care and quality, or unmeasured social and environmental stressors — may play a significant role in this disparity, Tucker said. This highlights the complex interplay of factors contributing to the increased risk.

The study also revealed that most cases of peripartum cardiomyopathy were identified after women were discharged from the hospital following delivery, highlighting the critical need for improved prenatal and postpartum care, particularly for high-risk patients. This underscores the importance of extended monitoring and support for new mothers.

Taylor stressed the importance of postpartum care.Access to postpartum care is crucial in detecting and managing peripartum cardiomyopathy, particularly because many cases are diagnosed only after hospital discharge, said Taylor. This emphasizes the need for comprehensive postpartum support and monitoring.

While the study focused on California data, Taylor noted that similar disparities exist nationwide. While the study is based on California hospital data,similar disparities in maternal health outcomes have been reported nationwide, Taylor noted. The racial gap in maternal deaths and severe complications is a persistent issue across the U.S., and other states with comparable health care disparities and demographic distributions would likely show similar trends, such as New York. This suggests that the findings are applicable to other regions with similar demographics and healthcare systems.

Both Tucker and Taylor emphasized the importance of recognizing the warning signs of peripartum cardiomyopathy, which include extreme tiredness, a fast or irregular heartbeat, and sudden swelling in the legs, feet, or belly. Other symptoms may include chest pain, dizziness or fainting, and a cough that brings up pink or frothy mucus. Tucker urged women experiencing severe symptoms to seek immediate medical attention: If your symptoms are severe—like intense chest pain or trouble breathing—don’t wait; call 911 or go to the emergency room. Early detection and intervention are crucial for improving outcomes.

Tucker’s future research will focus on investigating specific neighborhood factors and their relationship with peripartum cardiomyopathy outcomes.This will provide a more granular understanding of the environmental and socioeconomic factors contributing to the disparity.

Limitations of the study include a lack of detailed data on the severity of peripartum cardiomyopathy cases and the exclusion of cases that did not result in hospitalization. The study’s findings may also not be directly generalizable to other areas with different healthcare systems, population characteristics, and environmental factors. Additionally, the sample size was not large enough to estimate the risks associated with peripartum cardiomyopathy in American Indian, Alaska Native, and Asian American populations separately. These limitations highlight areas for future research and analysis.

The study analyzed 7,354,662 births,including non-Hispanic white,non-hispanic Black,Hispanic,and Asian ethnicities,with 918 identified cases of peripartum cardiomyopathy. Data was collected from hospital discharge records for mothers and infants up to 9 months after births in California from 2004 to 2019. Neighborhood resource level was measured using the Neighborhood Deprivation Index, which includes factors such as income, education level, adult unemployment, household crowding, and reliance on public assistance. Most peripartum cardiomyopathy cases were identified after women with symptoms were re-admitted to the hospital in the first two weeks after delivery. This detailed methodology provides a robust foundation for the study’s findings.

Mothers with severe peripartum cardiomyopathy were more likely to have risk factors such as preterm delivery, multiple births, more pre-existing medical conditions, pre-pregnancy high blood pressure, or a life-threatening event just before or after delivery. The most frequent co-occurring severe maternal condition was pulmonary edema/acute heart failure, present in 42.2% of peripartum cardiomyopathy cases. These factors highlight the complexity of managing peripartum cardiomyopathy and the need for comprehensive care.

Conclusion

The study’s findings underscore the urgent need for targeted interventions to address the disproportionate risk of peripartum cardiomyopathy among Black women and those in underserved communities. Enhanced prenatal and postpartum care, increased awareness of warning signs, and addressing systemic inequities in healthcare access are crucial steps toward improving maternal health outcomes and reducing the burden of this life-threatening condition. By focusing on these key areas, healthcare providers and policymakers can work together to create a more equitable and supportive environment for all mothers.