A Case-Control Study of Peripartum Cardiomyopathy Using the Rochester Epidemiology Project

•The incidence of peripartum cardiomyopathy in Olmsted County, Minnesota was 20.3 per 100,000 live births.•The recovery rate (left ventricular ejection fraction of ≥50%) was 89.6%, with no devices or transplants and 1 death.•Six of 23 women with subsequent pregnancies relapsed, but all recovered.•Infants born to women with peripartum cardiomyopathy were more likely to be premature or low birth weight.•Migraine and anxiety are newly identified risk factors for peripartum cardiomyopathy. The incidence of peripartum cardiomyopathy (PPCM) is known through referral center databases that may be affected by referral, misclassification, and other biases. We sought to determine the community-based incidence and natural history of PPCM using the Rochester Epidemiology Project. Incident cases of PPCM occurring between January 1, 1970, and December 31, 2014, were identified in Olmsted County, Minnesota. A total of 15 PPCM cases were confirmed yielding an incidence of 20.3 cases per 100,000 live births in Olmsted County, Minnesota. Clinical information, disease characteristics, and outcomes were extracted from medical records in a 27-county region of the Rochester Epidemiology Project including Olmsted County and matched in a 1:2 ratio with pregnant women without PPCM. A total of 48 women were identified with PPCM in the expanded 27-county region. There was 1 death and no transplants over a median of 7.3 years of follow-up. Six of the 23 women with subsequent pregnancies developed recurrent PPCM, all of whom recovered. Migraine and anxiety were identified as novel possible risk factors for PPCM. The population-based incidence of PPCM was 20.3 cases per 100,000 live births in Olmsted County, Minnesota. Cardiovascular outcomes were generally excellent in this community cohort.