Research Highlights:

  • Non-Hispanic Black women may be more than three times as likely as white women to develop peripartum cardiomyopathy, life-threatening heart failure that occurs in late pregnancy or a few months after delivery.
  • The analysis of more than 7 million births in California noted that the elevated risk among Black mothers could not be fully explained by socioeconomic status, neighborhood resources or a history of high blood pressure.
  • The findings underline the importance of accessible postpartum follow-up care and education to improve outcomes, according to study researchers.

For immediate release 4 a.m. CT/5 a.m. ET Tuesday, Feb. 25, 2025

DALLAS, Feb. 25 — Black mothers and those in under-resourced communities face a higher risk of developing a type of life-threatening heart failure during the late stages of pregnancy or the first few months after delivery, according to new research published today in a Go Red for Women® spotlight issue of the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

The spotlight issue focuses on research about sex differences in cardiovascular disease and their implications for care. The Association’s Go Red for Women initiative began more than two decades ago to help dispel myths and raise awareness of cardiovascular disease as the number one killer of women.

“The stark disparity identified in this study is deeply concerning but not entirely surprising,” said Journal of the American Heart Association associate editor Jacquelyn Y. Taylor, Ph.D., FAHA. “Racial disparities in maternal health outcomes are well-documented, often 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 this research.

Peripartum cardiomyopathy, diagnosed late in pregnancy or in the months after delivery, is rare, but in the past two decades has become more frequent and more deadly, according to lead study author Curisa M. Tucker, Ph.D., R.N., an assistant professor of nursing science at the University of South Carolina, College of Nursing in Columbia.

“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.”

Some risk factors for peripartum cardiomyopathy include having had two or more pregnancies, maternal age over 35 and pre-pregnancy high blood pressure. Still, sociodemographic factors can also play a role, Tucker said.

“Mothers in underserved or rural neighborhoods may face significant 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.”

In this analysis, investigators used 15 years of California hospital discharge records of more than 7 million births to analyze whether chronic high blood pressure or a lack of neighborhood resources, such as crowded housing or low-income level, could help explain the higher risk of the condition among non-Hispanic Black women.

The investigators found:

  • After adjusting for neighborhood and other factors, mothers living in neighborhoods with fewer resources had a higher risk of peripartum cardiomyopathy, with odds increasing by 20% to 70% with those living in areas with fewer resources having higher risk.
  • 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.
  • After adjusting for the neighborhood and other factors, non-Hispanic Black women were still 3.4 times as likely to develop peripartum cardiomyopathy as non-Hispanic white women.
  • 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..

“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.

Consistent with previous studies, researchers found that most cases of peripartum cardiomyopathy were identified after women were discharged from the hospital following delivery. The new results highlight the need for enhanced prenatal and postpartum care, especially for patients at higher risk for peripartum cardiomyopathy.

“Access to postpartum care is crucial in detecting and managing peripartum cardiomyopathy, particularly because many cases are diagnosed only after hospital discharge,” said Taylor, the Helen F. Petit Endowed Professor of Nursing and executive director of the Center for Research on People of Color at Columbia University in New York City.

“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.

Both Tucker and Taylor noted that it is important that women know the warning signs of peripartum cardiomyopathy: extreme tiredness; a fast or irregular heartbeat; or sudden swelling in the legs, feet or belly. Other symptoms include chest pain, dizziness or fainting and a cough that brings up pink or frothy mucus, Tucker added. “If your symptoms are severe—like intense chest pain or trouble breathing—don’t wait; call 911 or go to the emergency room.”

Tucker said her next project will investigate specific neighborhood factors, such as access to care, and their relationship with peripartum cardiomyopathy outcomes.

Study limitations include a lack of detailed information on the peripartum cardiomyopathy cases, including their severity. Also, only peripartum cardiomyopathy cases resulting in hospitalization were included in this analysis. The study used hospital records from California and the findings may not be directly generalizable to other areas with different health care 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.

Study details, background or design:

  • Researchers compared individual and community risk factors in 7,354,662 births that included non-Hispanic white, non-Hispanic Black, Hispanic and Asian ethnicities. In total, 918 were peripartum cardiomyopathy cases.
  • The data was from hospital discharge records for mothers and infants up to 9 months after births in California from 2004 to 2019. Fetal deaths were excluded from the analysis.
  • 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.
  • Mothers with severe peripartum cardiomyopathy were more likely to have risk factors such as preterm delivery (before 37 weeks gestation), multiple births, more pre-existing medical conditions, pre-pregnancy high blood pressure or a life-threatening event just before or after delivery (such as sudden heart failure, fluid build-up in the lungs or need for a blood transfusion).
  • The most frequent co-occurring severe maternal condition was pulmonary edema/acute heart failure (42.2% of peripartum cardiomyopathy cases).

Co-authors, disclosures and funding sources are listed in the manuscript.

Studies published in the American Heart Association’s scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

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