Cross-Sectional Analysis of the Association Between Abnormal Immune Responses in the Pathogenesis of Postpartum Cardiomyopathy in Ethiopian Women: A Hospital-based Study at Saint Paul Hospital

Abstract

Background- Postpartum cardiomyopathy (PPCM) is a condition that is characterized by the weakening of heart muscles which is known as left ventricular dysfunction and occurs during the later stages of pregnancy or during the early stages of postpartum. Objective- To evaluate the role of abnormal immune responses and risk factors such as advanced age, high parity, and presence of gestational diabetes in the pathogenesis of PPCM in Ethiopia. Method- A cross-sectional hospital-based study was conducted at Saint Paul Millennium Medical College (SPMCC) between January 2021 and January 2023. All female pregnant patients who were attending the Maternal Care Fetal Unit, Antenatal Unit, and High-Risk Unit at SPMMC were included in this study. However, among those patients, those mothers younger than 20 years old and older than 40 years old were excluded from the study. The total sample size collected from this facility was 250 patients. Results- Oxidative stress and inflammation were primarily correlated with pre-eclampsia and gestational diabetes. These risk factors were particularly prevalent within patients diagnosed with PPCM, 52.8% and 40% respectively. Prolactin Cleavage and Microvascular Dysfunction was associated with higher BMI and advanced age. With a general increasing trend observed in PPCM incidence and advancing age. As well as a high prevalence rate of PPCM in patients with Obesity Class I (at 33.0%). Another notable risk factor was high parity ( 45.0% with 4+ prior pregnancies). The most common symptom presented was dyspnea at 35.0%. The mortality rate was 14% whilst recurrence and the fully recovered ratio were at 13.1% and 34.0%, respectively. Conclusion- Results aligned with those conducted in other African countries (e.g. Zambia and South Africa) however mitigating high mortality as well as low full recovery rate will need to be done by earlier diagnosis, effective treatment, and intervention mechanisms. A different study design will need to be conducted (over a longer time period) to support and make findings more holistic.