{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T20:50:19Z","timestamp":1792615819508,"version":"4.5.0"},"reference-count":41,"publisher":"Georg Thieme Verlag KG","issue":"12","funder":[{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"crossref","award":["R01NR017020"],"award-info":[{"award-number":["R01NR017020"]}],"id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:p>Objective\u2003The aim of this study is to evaluate the contribution of pre-pregnancy obesity and overweight to peripartum cardiomyopathy.<\/jats:p><jats:p>Study Design\u2003This population-based study used linked birth record and maternal hospital discharge data from live births in California during 2007 to 2012 (n\u2009=\u20092,548,380). All women who had a diagnosis of peripartum cardiomyopathy during the childbirth hospitalization or who were diagnosed with peripartum cardiomyopathy during a postpartum hospital readmission within 5 months of birth were identified as cases. Pre-pregnancy body mass index (BMI, kg\/m2) was classified as normal weight (18.5\u201324.9), overweight (25.0\u201329.9), obesity class 1 (30.0\u201334.9), obesity class 2 (35.0\u201339.9), and obesity class 3 (\u226540). Because of small numbers, we excluded women with underweight BMI, and in some analyses, we combined obesity classes into one group. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) expressing associations between BMI and peripartum cardiomyopathy, adjusted for maternal age, race\/ethnicity, education, health care payer, parity, plurality, and comorbidities.<\/jats:p><jats:p>Results\u2003The overall prevalence of peripartum cardiomyopathy during hospital admissions was 1.3 per 10,000 live births (n\u2009=\u2009320). Unadjusted ORs were 1.32 (95% CI: 1.01\u20131.74) for women with overweight BMI and 2.03 (95% CI: 1.57\u20132.62) for women with obesity, compared with women with normal pre-pregnancy BMI. Adjusted ORs were 1.26 (95% CI: 0.95\u20131.66) for overweight women and 1.38 (95% CI: 1.04\u20131.84) for women with obesity. The ORs suggested a dose\u2013response relationship with increasing levels of obesity, but the 95% CIs for the specific classes of obesity included 1.00.<\/jats:p><jats:p>Conclusion\u2003Pre-pregnancy obesity was associated with an increased risk of peripartum cardiomyopathy. These findings underscore the importance of BMI during pregnancy. There is a need to recognize the increased risk of peripartum cardiomyopathy in women with high BMI, especially in the late postpartum period.<\/jats:p><jats:p>Key Points<\/jats:p>","DOI":"10.1055\/s-0040-1712451","type":"journal-article","created":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T23:19:45Z","timestamp":1591658385000},"page":"1289-1296","source":"Crossref","is-referenced-by-count":15,"title":["Pre-pregnancy Obesity and the Risk of Peripartum Cardiomyopathy"],"prefix":"10.1055","volume":"38","author":[{"given":"Seo-Ho","family":"Cho","sequence":"additional","affiliation":[{"name":"Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie A.","family":"Leonard","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey","family":"Lyndon","sequence":"additional","affiliation":[{"name":"Rory Meyers College of Nursing, New York University, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elliott K.","family":"Main","sequence":"additional","affiliation":[{"name":"California Maternal Quality Care Collaborative, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Abrams","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afshan B.","family":"Hameed","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine School of Medicine, Irvine, California"},{"name":"Division of Cardiology, Department of Medicine, University of California Irvine School of Medicine, Irvine, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzan L.","family":"Carmichael","sequence":"additional","affiliation":[{"name":"Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California"},{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,6,8]]},"reference":[{"issue":"16","key":"ref1","doi-asserted-by":"crossref","first-page":"2050","DOI":"10.1161\/01.CIR.0000162478.36652.7E","article-title":"Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation","volume":"111","author":"U Elkayam","year":"2005","journal-title":"Circulation"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.preghy.2018.06.018","article-title":"Peripartum cardiomyopathy: an epidemiologic study of early and late presentations","volume":"13","author":"R Masoomi","year":"2018","journal-title":"Pregnancy Hypertens"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1002\/ejhf.1178","article-title":"Long-term prognosis, subsequent pregnancy, contraception and overall management of peripartum cardiomyopathy: practical guidance paper from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy","volume":"20","author":"K Sliwa","year":"2018","journal-title":"Eur J Heart Fail"},{"key":"ref4","first-page":"160","volume-title":"Management of cardiomyopathies in pregnancy","author":"C Nelson-Piercy","year":"2016"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"e001056","DOI":"10.1161\/JAHA.114.001056","article-title":"Temporal trends in incidence and outcomes of peripartum cardiomyopathy in the United States: a nationwide population-based study","volume":"3","author":"D Kolte","year":"2014","journal-title":"J Am Heart Assoc"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1097\/AOG.0b013e31826e46a1","article-title":"Peripartum cardiomyopathy: population-based birth prevalence and 7-year mortality","volume":"120","author":"M A Harper","year":"2012","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1097\/AOG.0b013e318229e6de","article-title":"Epidemiology of peripartum cardiomyopathy: incidence, predictors, and outcomes","volume":"118","author":"E P Gunderson","year":"2011","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"379.e1","DOI":"10.1016\/j.ajog.2015.05.008","article-title":"Pregnancy-related cardiovascular deaths in California: beyond peripartum cardiomyopathy","volume":"213","author":"A B Hameed","year":"2015","journal-title":"Am J Obstet Gynecol"},{"issue":"08","key":"ref9","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1093\/eurjhf\/hfq120","article-title":"Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy","volume":"12","author":"K Sliwa","year":"2010","journal-title":"Eur J Heart Fail"},{"issue":"07","key":"ref10","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.jacc.2011.03.047","article-title":"Clinical characteristics of peripartum cardiomyopathy in the United States: diagnosis, prognosis, and management","volume":"58","author":"U Elkayam","year":"2011","journal-title":"J Am Coll Cardiol"},{"issue":"18","key":"ref11","doi-asserted-by":"crossref","first-page":"423","DOI":"10.15585\/mmwr.mm6818e1","article-title":"Vital signs: pregnancy-related deaths, United States, 2011-2015, and strategies for prevention, 13 states, 2013-2017","volume":"68","author":"E E Petersen","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/S0002-9378(98)80034-3","article-title":"Peripartum cardiomyopathy: a comprehensive review","volume":"178","author":"C S Brown","year":"1998","journal-title":"Am J Obstet Gynecol"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/S0140-6736(06)69253-2","article-title":"Peripartum cardiomyopathy","volume":"368","author":"K Sliwa","year":"2006","journal-title":"Lancet"},{"issue":"18","key":"ref14","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1016\/j.jacc.2013.08.717","article-title":"The relationship between pre-eclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis","volume":"62","author":"N Bello","year":"2013","journal-title":"J Am Coll Cardiol"},{"issue":"08","key":"ref15","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s11906-018-0868-9","article-title":"Peripartum cardiomyopathy and preeclampsia: overlapping diseases of pregnancy","volume":"20","author":"P Parikh","year":"2018","journal-title":"Curr Hypertens Rep"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"e0211857","DOI":"10.1371\/journal.pone.0211857","article-title":"Hypertensive disorders of pregnancy and peripartum cardiomyopathy: a nationwide cohort study","volume":"14","author":"I Behrens","year":"2019","journal-title":"PLoS One"},{"issue":"05","key":"ref17","doi-asserted-by":"crossref","first-page":"843","DOI":"10.5665\/sleep.3644","article-title":"Obstructive sleep apnea and severe maternal-infant morbidity\/mortality in the United States, 1998-2009","volume":"37","author":"J M Louis","year":"2014","journal-title":"Sleep (Basel)"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1515\/jpm-2014-0086","article-title":"Peripartum cardiomyopathy \u2013 risk factors, characteristics and long-term follow-up","volume":"43","author":"H Shani","year":"2015","journal-title":"J Perinat Med"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/S0002-9378(97)80033-6","article-title":"Peripartum cardiomyopathy: an ominous diagnosis","volume":"176","author":"A G Witlin","year":"1997","journal-title":"Am J Obstet Gynecol"},{"key":"ref20","first-page":"85","volume-title":"Peripartum Cardiomyopathy and Pulmonary Edema","author":"R Loftin","year":"2011"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.15585\/mmwr.mm665152a3","article-title":"Prevalence and trends in prepregnancy normal weight - 48 states, New York City, and District of Columbia, 2011-2015","volume":"66","author":"N P Deputy","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"04","key":"ref23","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1093\/cvr\/cvu014","article-title":"Pregnancy, cardiomyopathies, and genetics","volume":"101","author":"J P Van Tintelen","year":"2014","journal-title":"Cardiovasc Res"},{"issue":"09","key":"ref24","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1038\/ncpcardio0964","article-title":"Obesity cardiomyopathy: diagnosis and therapeutic implications","volume":"4","author":"C Wong","year":"2007","journal-title":"Nat Clin Pract Cardiovasc Med"},{"issue":"05","key":"ref25","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.jchf.2013.04.011","article-title":"Characteristics, adverse events, and racial differences among delivering mothers with peripartum cardiomyopathy","volume":"1","author":"D P Kao","year":"2013","journal-title":"JACC Heart Fail"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.preghy.2019.05.014","article-title":"Peripartum cardiomyopathy with co-incident preeclampsia: a cohort study of clinical risk factors and outcomes among commercially insured women","volume":"17","author":"I Malham\u00e9","year":"2019","journal-title":"Pregnancy Hypertens"},{"issue":"10","key":"ref27","doi-asserted-by":"crossref","first-page":"756","DOI":"10.2459\/JCM.0000000000000222","article-title":"Epidemiology and outcomes of peripartum cardiomyopathy in the United States: findings from the Nationwide Inpatient Sample","volume":"17","author":"P Krishnamoorthy","year":"2016","journal-title":"J Cardiovasc Med (Hagerstown)"},{"issue":"01","key":"ref28","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1097\/AOG.0b013e3181c4ee8c","article-title":"Cardiomyopathy and other myocardial disorders among hospitalizations for pregnancy in the United States: 2004-2006","volume":"115","author":"E V Kuklina","year":"2010","journal-title":"Obstet Gynecol"},{"issue":"09","key":"ref29","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1001\/jama.283.9.1183","article-title":"Peripartum cardiomyopathy: national heart, lung, and blood institute and office of rare diseases (national institutes of health) workshop recommendations and review","volume":"283","author":"G D Pearson","year":"2000","journal-title":"JAMA"},{"issue":"04","key":"ref30","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1111\/j.1475-6773.2007.00822.x","article-title":"Assessing validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions in a unique dually coded database","volume":"43","author":"H Quan","year":"2008","journal-title":"Health Serv Res"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/1472-6963-14-70","article-title":"Coding of obesity in administrative hospital discharge abstract data: accuracy and impact for future research studies","volume":"14","author":"B-J Martin","year":"2014","journal-title":"BMC Health Serv Res"},{"issue":"08","key":"ref32","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1038\/ncpcardio0943","article-title":"Obesity cardiomyopathy: pathogenesis and pathophysiology","volume":"4","author":"C Wong","year":"2007","journal-title":"Nat Clin Pract Cardiovasc Med"},{"issue":"03","key":"ref33","doi-asserted-by":"crossref","first-page":"e175","DOI":"10.1016\/j.orcp.2012.02.011","article-title":"A perspective on obesity cardiomyopathy","volume":"6","author":"T Timoh","year":"2012","journal-title":"Obes Res Clin Pract"},{"issue":"04","key":"ref34","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1097\/00000441-200104000-00003","article-title":"Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome","volume":"321","author":"M A Alpert","year":"2001","journal-title":"Am J Med Sci"},{"issue":"03","key":"ref35","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.ccm.2009.06.001","article-title":"Role of obesity in cardiomyopathy and pulmonary hypertension","volume":"30","author":"C S Dela Cruz","year":"2009","journal-title":"Clin Chest Med"},{"issue":"01","key":"ref36","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.ajog.2005.02.096","article-title":"The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data","volume":"193","author":"M T Lydon-Rochelle","year":"2005","journal-title":"Am J Obstet Gynecol"},{"issue":"03","key":"ref37","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1111\/obr.12486","article-title":"The accuracy of self-reported pregnancy-related weight: a systematic review","volume":"18","author":"I Headen","year":"2017","journal-title":"Obes Rev"},{"issue":"01","key":"ref38","doi-asserted-by":"crossref","first-page":"x","DOI":"10.1515\/crpm-2013-0052","article-title":"Extraordinary weight gain: initial finding in a patient with peripartum cardiomyopathy","volume":"3","author":"D Endo","year":"2014","journal-title":"Case Reports Perinatal Medicine"},{"key":"ref39","first-page":"317146","article-title":"Gestational weight gain and peripartum cardiomyopathy in a twin pregnancy","volume":"2015","author":"H Matsumiya","year":"2015","journal-title":"Case Rep Obstet Gynecol"},{"issue":"04","key":"ref40","doi-asserted-by":"crossref","first-page":"x","DOI":"10.21767\/2471-9803.100028","article-title":"Gestational weight gain in a woman with peripartum cardiomyopathy","volume":"2","author":"A Sakamoto","year":"2016","journal-title":"Crit Care Obst Gyne"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"2014","DOI":"10.1136\/bcr-2014-208186","article-title":"Peripartum cardiomyopathy in a woman with preeclampsia with twin pregnancy","volume":"2014","author":"T Umazume","year":"2014","journal-title":"BMJ Case Rep"},{"issue":"01","key":"ref43","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12884-018-2169-3","article-title":"The contribution of maternal characteristics and cesarean delivery to an increasing trend of severe maternal morbidity","volume":"19","author":"S A Leonard","year":"2019","journal-title":"BMC Pregnancy Childbirth"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0040-1712451.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T04:30:54Z","timestamp":1696221054000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0040-1712451"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,8]]},"references-count":41,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,9,22]]},"published-print":{"date-parts":[[2021,10]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0040-1712451","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,8]]}}}