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Am J Perinatol 2019; 36(05): 476-483
DOI: 10.1055/s-0038-1669439
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Maternal Obesity Affects Cardiac Remodeling and Recovery in Women with Peripartum Cardiomyopathy

Esa M. Davis
1   Department of Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Gregory Ewald
2   Department of Medicine, Washington University, St. Louis, Missouri
,
Michael M. Givertz
3   Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
,
Navin Rajagopalan
4   Department of Medicine, University of Kentucky, Lexington, Kentucky
,
Leslie T. Cooper Jr
5   Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
,
Joan Briller
6   Department of Medicine, University of Illinois at Chicago, Illinois
,
G. Michael Felker
7   Department of Medicine, Duke University, Durham, North Carolina
,
Biykem Bozkurt
8   Department of Medicine, Baylor College of Medicine, Houston, Texas
,
Mark H. Drazner
9   Department of Medicine, UT Southwestern Medical Center, Dallas, Texas
,
Karen Hanley-Yanez
10   Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Indrani Halder
10   Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Charles F. McTiernan
10   Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Dennis M. McNamara
10   Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
,
on behalf of the IPAC Investigators › Author Affiliations Funding This study was supported by the National Institutes of Health (NIH) contracts HL102429 and HL069912 and by an internal PATH grant through the University of Pittsburgh School of Medicine. The NIH had no involvement in the study design, data collection, interpretation or analysis, writing of the manuscript, or submission for publication.
Further Information

Publication History

09 May 2018

11 July 2018

Publication Date:
05 September 2018 (online)

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Abstract

Objective To examine the association between maternal obesity on left ventricular (LV) size and recovery in women with peripartum cardiomyopathy (PPCM).

Study Design This was a prospective analysis of 100 women enrolled within 13 weeks of PPCM diagnosis and followed for a year in the Investigation of Pregnancy Associated Cardiomyopathy study. Adiposity was defined by standard body mass index (BMI) definitions for under/normal weight, overweight, and obesity. Demographic, clinical, and biomarker variables were compared across weight categories.

Outcomes LV end-diastolic diameter (LVEDD) and ejection fraction were measured at entry, 6, and 12 months postpartum. Multivariable regression models examined the relationship between adiposity, LV size, and leptin levels with cardiac recovery at 6 and 12 months postpartum.

Results Obese and nonobese women had similar LV dysfunction at entry. Obese women had greater LV size and less LV recovery at 6 and 12 months postpartum. BMI was positively associated with leptin and ventricular diameter. Greater BMI at entry remained associated with less ventricular recovery at 6 months (p = 0.02) in adjusted race-stratified models. LVEDD at entry predicted lower ejection fraction at 6 months (p < 0.001) and similarly at 12 months.

Conclusion Obese women with PPCM had greater cardiac remodeling, higher leptin levels, and diminished cardiac recovery.

Keywords

peripartum cardiomyopathy - obesity - pregnancy - nonischemic cardiomyopathy - maternal leptin - left ventricular ejection fraction - left ventricular end-diastolic diameter

Note

Findings from this study were presented in a poster presentation at the 2015 American Heart Association Annual Meeting, November 8, 2015, Orlando, FL.


Ethical Approval

Drs. McNamara and Davis had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. All the authors have met the journal's requirements for authorship.


* Please see Appendix A for the full list of IPAC investigators.


Supplementary Material

 

  • References

  • 1 Viswanathan M, Siega-Riz AM, Moos MK. , et al. Outcomes of maternal weight gain. Evid Rep Technol Assess (Full Rep) 2008; (168) 1-223
    PubMedGoogle Scholar
  • 2 Garg J, Palaniswamy C, Lanier GM. Peripartum cardiomyopathy: definition, incidence, etiopathogenesis, diagnosis, and management. Cardiol Rev 2015; 23 (02) 69-78
    CrossrefPubMedGoogle Scholar
  • 3 Kenchaiah S, Evans JC, Levy D. , et al. Obesity and the risk of heart failure. N Engl J Med 2002; 347 (05) 305-313
    CrossrefPubMedGoogle Scholar
  • 4 Horwich TB, Fonarow GC, Hamilton MA, MacLellan WR, Woo MA, Tillisch JH. The relationship between obesity and mortality in patients with heart failure. J Am Coll Cardiol 2001; 38 (03) 789-795
    CrossrefPubMedGoogle Scholar
  • 5 Lavie CJ, Osman AF, Milani RV, Mehra MR. Body composition and prognosis in chronic systolic heart failure: the obesity paradox. Am J Cardiol 2003; 91 (07) 891-894
    CrossrefPubMedGoogle Scholar
  • 6 Gustafsson F, Kragelund CB, Torp-Pedersen C. , et al; DIAMOND study group. Effect of obesity and being overweight on long-term mortality in congestive heart failure: influence of left ventricular systolic function. Eur Heart J 2005; 26 (01) 58-64
    CrossrefPubMedGoogle Scholar
  • 7 Blauwet LA, Libhaber E, Forster O. , et al. Predictors of outcome in 176 South African patients with peripartum cardiomyopathy. Heart 2013; 99 (05) 308-313
    PubMedGoogle Scholar
  • 8 Schubring C, Englaro P, Siebler T. , et al. Longitudinal analysis of maternal serum leptin levels during pregnancy, at birth and up to six weeks after birth: relation to body mass index, skinfolds, sex steroids and umbilical cord blood leptin levels. Horm Res 1998; 50 (05) 276-283
    CrossrefPubMedGoogle Scholar
  • 9 El Shahat AM, Ahmed AB, Ahmed MR, Mohamed HS. Maternal serum leptin as a marker of preeclampsia. Arch Gynecol Obstet 2013; 288 (06) 1317-1322
    CrossrefPubMedGoogle Scholar
  • 10 Karmazyn M, Rajapurohitam V. Leptin as a cardiac pro-hypertrophic factor and its potential role in the development of heart failure. Curr Pharm Des 2014; 20 (04) 646-651
    CrossrefPubMedGoogle Scholar
  • 11 McNamara DM, Starling RC, Cooper LT. , et al; IMAC Investigators. Clinical and demographic predictors of outcomes in recent onset dilated cardiomyopathy: results of the IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study. J Am Coll Cardiol 2011; 58 (11) 1112-1118
    CrossrefPubMedGoogle Scholar
  • 12 World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894: i-xii , 1–253
    PubMedGoogle Scholar
  • 13 Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986; 51 (06) 1173-1182
    CrossrefPubMedGoogle Scholar
  • 14 Cooper LT, Mather PJ, Alexis JD. , et al; IMAC2 Investigators. Myocardial recovery in peripartum cardiomyopathy: prospective comparison with recent onset cardiomyopathy in men and nonperipartum women. J Card Fail 2012; 18 (01) 28-33
    CrossrefPubMedGoogle Scholar
  • 15 Stein TP, Scholl TO, Schluter MD, Schroeder CM. Plasma leptin influences gestational weight gain and postpartum weight retention. Am J Clin Nutr 1998; 68 (06) 1236-1240
    CrossrefPubMedGoogle Scholar
  • 16 Jéquier E. Leptin signaling, adiposity, and energy balance. Ann N Y Acad Sci 2002; 967: 379-388
    PubMedGoogle Scholar
  • 17 Singh P, Sharma P, Sahakyan KR. , et al. Differential effects of leptin on adiponectin expression with weight gain versus obesity. Int J Obes 2016; 40 (02) 266-274
    CrossrefPubMedGoogle Scholar
  • 18 MacDougald OA, Hwang CS, Fan H, Lane MD. Regulated expression of the obese gene product (leptin) in white adipose tissue and 3T3-L1 adipocytes. Proc Natl Acad Sci U S A 1995; 92 (20) 9034-9037
    CrossrefPubMedGoogle Scholar
  • 19 Rentsch J, Chiesi M. Regulation of ob gene mRNA levels in cultured adipocytes. FEBS Lett 1996; 379 (01) 55-59
    CrossrefPubMedGoogle Scholar
  • 20 Kolaczynski JW, Nyce MR, Considine RV. , et al. Acute and chronic effects of insulin on leptin production in humans: studies in vivo and in vitro. Diabetes 1996; 45 (05) 699-701
    CrossrefPubMedGoogle Scholar
  • 21 Grinspoon SK, Askari H, Landt ML. , et al. Effects of fasting and glucose infusion on basal and overnight leptin concentrations in normal-weight women. Am J Clin Nutr 1997; 66 (06) 1352-1356
    CrossrefPubMedGoogle Scholar
  • 22 McGaffin KR, Moravec CS, McTiernan CF. Leptin signaling in the failing and mechanically unloaded human heart. Circ Heart Fail 2009; 2 (06) 676-683
    CrossrefPubMedGoogle Scholar
  • 23 Hilfiker-Kleiner D, Sliwa K. Pathophysiology and epidemiology of peripartum cardiomyopathy. Nat Rev Cardiol 2014; 11 (06) 364-370
    CrossrefPubMedGoogle Scholar