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

Area of Science:

• Cardiology
• Maternal Health
• Health Disparities

Background:

• Peripartum cardiomyopathy (PPCM) is a significant cause of heart failure during pregnancy, disproportionately affecting Black women.
• Black women with PPCM experience worse maternal morbidity and mortality outcomes compared to other racial groups.

Purpose of the Study:

• To quantify differences in risk factors and outcomes between Black and White women diagnosed with PPCM in the U.S.
• To analyze race-stratified data for peripartum cardiomyopathy cases.

Main Methods:

• Systematic review and meta-analysis of observational studies published after 2002 involving U.S. women with PPCM.
• Analysis of risk factors (obesity, preeclampsia, diabetes, etc.) and outcomes (mortality, cardiac events, ejection fraction recovery).
• Utilized random-effects meta-analysis, logistic regression, and forest plots for data synthesis.

Main Results:

• Black PPCM cases showed higher prevalence of diabetes (14% vs 5%) and public payer utilization (72% vs 30%) compared to White cases.
• Mean left ventricular ejection fraction at presentation was lower in Black women (26%) versus White women (29%).
• White women had significantly higher ejection fraction recovery rates (63% vs 40%) and lower mortality rates (2% vs 8%) compared to Black women.

Conclusions:

• Black women with PPCM experience poorer outcomes, including lower recovery rates and higher mortality, compared to White women.
• Modest differences in risk factors, apart from payer status, do not fully explain the observed disparities in PPCM outcomes.
• Findings underscore the need for targeted interventions to address racial disparities in peripartum cardiomyopathy care.