Academic journal article Journal of Health Population and Nutrition

Emerging Insights into Peripartum Cardiomyopathy

Academic journal article Journal of Health Population and Nutrition

Emerging Insights into Peripartum Cardiomyopathy

Article excerpt

INTRODUCTION

Peripartum cardiomyopathy (PPCM) is rare in most developed countries. However, it is relatively common in the Hospital Albert Schweitzer (HAS) district of Haiti (Unite Communautaire de Sante de Petite Riviere, Verettes, et LaChapelle) (1). PPCM is defined as the new onset of congestive heart failure (CHF) during the time from one month antepartum to five months postpartum without other explanation for CHF and with no prior history of heart disease (2). The HAS PPCM Project also requires specific echocardiographic criteria of left ventricular dilatation and decreased contractility (1). An incidence of PPCM in the HAS district of approximately one case per 400 livebirths has encouraged and made possible an ongoing intensive investigation of epidemiologic and immunohaematologic aspects of this disease in this population (1,3,4). This report describes the results of case-control studies and an expanding base of epidemiological field information about PPCM in the HAS district.

MATERIALS AND METHODS

Study site

The HAS district is a 30x40 km area in west central Haiti. The population served is approximately 258,000. There are approximately 7,740 livebirths annually. One other small hospital and one maternity unit are located within the district. They regularly refer seriously ill patients to the HAS. It is estimated that at least 95% of the PPCM mothers in the district will be seen at the HAS with their initial CHF. The HAS district is divided into seven functional units, three of which are located in the higher hills and four located on the Artibonite River Valley floor. In addition to the central hospital, there is a community health department supervising two larger health centres and five rural dispensaries. No dependable income data exist. In the population studied, fathers are peasant farmers and mothers are home-makers in addition to some agricultural activities. Both supplement income from small sales of agricultural products and common household items.

PPCM cases

All PPCM cases were identified from the HAS PPCM Registry which was initiated on 1 February 2000 and contained 74 entries on 1 September 2002. One author (JDF) developed the registry form, containing 72 separate pieces of information eventually entered into the computer database. Of the 74 registrants, 14 were from outside the HAS district and were not accessible to the follow-up network. They were not included in the epidemiological questionnaire study. The remaining 60 in-district PPCM patients are the source of clinical data, calculation of incidence and mortality rates, and follow-up echocardiographic data. Case-control study I included both retrospective and prospective cases. At that time, the Registry contained 45 in-district cases. Ten of these did not complete the questionnaire either because of death or being lost to follow-up, leaving 35 PPCM patients on 1 October 2001 for inclusion in case-control study I. Case-control study II included only 40 prospectively-identified cases. Seven of these had not completed the questionnaire either because of death or being lost to follow-up, leaving 33 prospectively-identified PPCM patients on 1 September 2002 for inclusion in case-control study II.

Controls

Control Haitian mothers for case-control study I were selected randomly from the HAS Women's Health Registry. Following initial recommendations for parity-matching with PPCM patients, the goal was to identify equal numbers of mothers from each of the three groups: (1) 1 to 2 pregnancy(ies), (2) 3 to 4 pregnancies, and (3) 5 or more pregnancies. In this selection process, 37 control Haitian mothers participated. When it was discovered that parity-matching in this way resulted in selection of controls who were further postpartum than the PPCM mothers at time of diagnosis, it was decided to do a second round of control selection for case-control study II. In addition, it had become clear by this time that all PPCM cases were being identified from the valley units and none from the hill units. …

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