Association Between Diabetes During Pregnancy and Peripartum Cardiomyopathy: A Population-Level Analysis of 309,825 Women
Association Between Diabetes During Pregnancy and Peripartum Cardiomyopathy: A Population-Level Analysis of 309,825 Women
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DOI：
10.1016/j.cjca.2017.02.008
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发表时间：
2017-07-01
影响因子：
6.2
通讯作者：
Kaul, Padma
中科院分区：
文献类型：
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作者：
Dhesi, Sumandeep;Savu, Anamaria;Kaul, Padma
背景：围产期心肌病（PPCM）是一种与妊娠相关的心力衰竭。我们研究的目的是确定发生率和结果PPCM的母亲和新生儿及其与糖尿病（DM）在当代人群为基础的队列的关联。该队列由309，825名在2005年1月1日至2014年9月30日期间出生至少1名活产新生儿的女性组成，导致469名，150例出生事件和477，089例活产新生儿。使用修改后的PPCM定义，允许从妊娠32周到产后6个月。妇女根据DM状态进行分类。结果：共确定了194 PPCM出生事件，发病率为1/2418出生。患有PPCM的妇女年龄较大，经常是未经产，更可能有多胎妊娠，既存糖尿病和妊娠期高血压疾病。尽管总体数量较低，但与既存DM（1/613起出生事件）和妊娠期DM（1/1751起出生事件）的女性相比，既存DM（1/613起出生事件）和妊娠期DM（1/1751起出生事件）的女性妊娠期PPCM的发生率较高。在平均3.9年的随访中，受PPCM影响的妇女的死亡率高于未受影响的妇女，总体死亡人数很少。新生儿死亡是不常见的，在整个队列，但在PPCM group.Conclusions：PPCM在加拿大阿尔伯塔省的发病率约为1/2400出生和调制的存在下，糖尿病在怀孕期间。糖尿病状态和PPCM之间的关系可能会受到其他血管危险因素的混淆，包括妊娠期高血压疾病。在整个队列中，产妇或新生儿死亡很少，但在PPCM组中，产妇或新生儿死亡人数较高。
Background: Peripartum cardiomyopathy (PPCM) is a form of heart failure associated with pregnancy. The objectives of our study were to determine the incidence and outcomes (maternal and neonatal) of PPCM and its association with diabetes mellitus (DM) in a contemporary population-based cohort.Methods: The cohort consisted of 309,825 women with a birth of at least 1 live newborn between January 01, 2005 and September 30, 2014, resulting in 469,150 birth events and 477,089 live newborns. A modified PPCM definition was used, allowing from 32 weeks' gestation and up to 6 months postpartum. Women were categorized according to DM status.Results: A total of 194 PPCM birth events were identified, for an incidence rate of 1/2418 births. Women with PPCM were older, often primiparous, and more likely to have multiple gestations, pre-existing DM, and hypertensive disorders of pregnancy. Although the overall numbers were low, the incidence of PPCM was higher in pregnancies in women with pre-existing DM (1/613 birth events) and gestational DM (1/1751 birth events) vs those with neither (1/2550 birth events). Over a mean follow-up of 3.9 years, the mortality rate was higher in women affected by PPCM than in those who were not, with few deaths overall. Neonatal death was uncommon in the entire cohort but was numerically greater in the PPCM group.Conclusions: The incidence of PPCM in Alberta, Canada was approximately 1/2400 births and was modulated by the presence of DM in pregnancy. The relationship between DM status and PPCM may be confounded by other vascular risk factors, including hypertensive disorders of pregnancy. There were few maternal or neonatal deaths in the overall cohort, but they were numerically higher in the PPCM group.