“Maternal health remains a staggering challenge” – Jessica Capshaw
From the paper, “Hypertension in pregnancy as the most influential risk factor for PPCM”.
Peri-partum cardiomyopathy (PPCM) is a disease that affects the heart muscle, reducing heart function which can lead to heart failure in women during late pregnancy or just after giving birth. In the US, PPCM effects between 2,500 to 4,000 pregnancies. PPCM is one of the leading causes of maternal mortality worldwide and caused 228 maternal deaths per 100,000 live births in Indonesia in 2012.
There are various risk factors associated with developing PPCM, which can differ depending on race. For example, those from Africa have an increased risk of developing PPCM if they have hypertension. Hypertension is when an individual has high blood pressure (1). In Africa, having pre-eclampsia as a form of hypertension is thought to be the leading cause of PPCM in these patients. Pre-eclampsia is high blood pressure during pregnancy and having a high amount of protein with urine, which is abnormal (2). However, no study has been done to determine the main risk factor for PPCM in Southeast Asia, which is what this study aimed to achieve by investigating the Javanese population in Indonesia. The study took 96 patients with PPCM and 96 patients without PPCM and collected data that they believed could be important in determining important risk factors for PPCM. All the data were collected from one hospital in West Java, Indonesia.
The investigation collected data for the following characteristics from both groups of patients:
- Socioeconomic factor (Income per year)
- Number of successful pregnancies
- Whether they had been pregnancy before including miscarriages
- History of chronic hypertension (hypertension over a long time period)
- History of hypertension in previous pregnancy
- Hypertension in current pregnancy
- Multi-foetal pregnancy
- Baby delivery type
- Duration of pregnancy
The data was analysed and statistically significant results determined in terms of being a risk factor for PPCM. In these cases within this investigation, statistically significant means that it is possible that having a certain characteristic could increase your chances of developing PPCM.
The graphs show the factors and the data collected for those characteristics that are statistically significant for developing PPCM. The graphs show the percentage of people affected by the characteristic.
Further analysis of the data revealed the following:
- You are 3.312 times more likely to develop PPCM if you have a low income per year.
- You are 4.862 times more likely to develop PPCM if you have had hypertension in a previous pregnancy.
- You are 2.311 times more likely to develop PPCM if you have hypertension in the current pregnancy.
- You are 7.057 times more likely to develop PPCM if you have a multi-foetal pregnancy.
Interesting, you are twice as likely to develop PPCM if your pregnancy is less than 35 weeks long, but this proved to be statistically insignificant.
The results from the investigation have suggested that, in this Javanese group, hypertension in previous and in the current pregnancy is the most influential risk factor for developing PPCM. Despite multi-foetal pregnancy giving a higher risk of PPCM, combining the two hypertension categories together results in a much greater risk of developing PPCM.
A potential mechanism for PPCM development due to pregnancy hypertension lies within the placenta. The placenta produces anti-angiogenic factors in late pregnancy. Anti-angiogenic factors are molecules that stop the development of new blood vessels (3). These factors will bind to growth factors that produce blood vessels and prevent them from working, resulting in a disruption to the balance of blood vessels in the mother. This can lead to cardiotoxic effects on the wall of the heart. If the women does not have enough resistance to this, the cardiotoxic effects can lead to PPCM and potentially heart failure causing mortality.
This is a good study, however, it has only looked into a small group of Javanese people in one hospital in Indonesia. More research should be done in other hospitals in Indonesia to prove whether the results of this research are valid. More research should also be done worldwide to see if there is a global relationship between PPCM and hypertension during pregnancy. Research should also be conducted into the causes of hypertension during pregnancy and into the type of hypertension, as there are more types than pre-eclampsia.
If PPCM is detected early enough, then the effects of cardiotoxicity can be reversed within six months after the baby has been born. This has been seen in about 40% of individuals when PPCM has been detected. Therefore, more public knowledge about PPCM should be a priority for healthcare officials, which this paper has stated. PPCM can be prevented.
— By Daniel Baird
(1) Carissa Stephens, C. (2018). Hypertension: Causes, symptoms, and treatments. [online] Medical News Today. Available at: https://www.medicalnewstoday.com/articles/150109.php [Accessed 24 Jul. 2018].
(2) nhs.uk. (2018). Pre-eclampsia. [online] Available at: https://www.nhs.uk/conditions/pre-eclampsia/ [Accessed 24 Jul. 2018].
(3) TheFreeDictionary.com. (2018). antiangiogenic. [online] Available at: https://medical-dictionary.thefreedictionary.com/antiangiogenic [Accessed 24 Jul. 2018].