Racial disparities in severe maternal morbidity among peripartum cardiomyopathy deliveries
A Bolad, M Elganainy, I Motairek, F Alenezi, I BoladAbstract
Background
Peripartum cardiomyopathy (PPCM) is one of the most severe cardiovascular complications of pregnancy and a leading cause of maternal death in high-income countries. Although racial inequities in maternal cardiac outcomes are increasingly recognized, population-level data on racial and socioeconomic disparities in severe maternal morbidity (SMM) among PPCM hospitalizations are lacking. The purpose of study was to assess differences in composite and individual SMM indicators by race/ethnicity and neighborhood income among U.S. delivery hospitalizations complicated by PPCM.
Methods
Using the 2016–2022 National Inpatient Sample, we identified delivery hospitalizations with PPCM (ICD-10-CM O90.3). The primary outcome was CDC-defined composite SMM (excluding transfusion). Exposures included race/ethnicity (white reference, black, hispanic, asian, native american, other) and income quartile. Survey-weighted logistic models sequentially adjusted for demographics, comorbidities, and hospital characteristics. Secondary outcomes were individual SMM indicators, in-hospital mortality, length of stay (LOS), and total charges.
Results
The study included an estimated 5,560 PPCM delivery hospitalizations (unweighted n = 1,112). Composite SMM prevalence was 67.9% and in-hospital mortality 1.44%. The most common indicators were acute heart failure (53.1%), ARDS (34.8%), and mechanical ventilation (15.2%). Hispanic patients had the highest SMM rate (78.6%, p = 0.044). In fully adjusted models, hispanic race remained independently associated with greater odds of composite SMM (aOR 1.91, 95% CI 1.16–3.14, p = 0.011) and sepsis (aOR 3.55, 95% CI 1.90–6.64, p < 0.001). Black, hispanic, and asian patients also had higher odds of transfusion (all p ≤ 0.02). Charlson comorbidity index was the strongest predictor of SMM (aOR 5.45 per unit, p < 0.0001). Income quartile was not significant in any model. Black patients had longer LOS (+1.6 days, p = 0.015), and Hispanic patients had $33,551 higher adjusted total charges (p = 0.009).
Conclusion
Two-thirds of PPCM delivery hospitalizations involved severe maternal morbidity, emphasizing the acuity of this problem in cardio-obstetric. Hispanic women experienced a 91% higher adjusted risk of composite SMM and over triple the odds of sepsis versus white counterparts, disparities that persisted after accounting for comorbidities, socioeconomic factors, and hospital characteristics. Income was not independently linked to SMM, indicating that race-specific structural and biological factors may drive inequities. These findings spotlight hispanic women as an underrecognized high-risk group for adverse in-hospital outcomes and emphasize the need for race-stratified PPCM management protocols, with heightened sepsis monitoring and multidisciplinary critical care.