Living in a disadvantaged neighborhood contributes to a rare form of heart failure known as peripartum cardiomyopathy, a potentially deadly disease that disproportionately affects Black mothers.
That’s the key finding of my recent study, published in February 2025 in the Journal of the American Heart Association.
Peripartum cardiomyopathy can occur in pregnant or postpartum mothers during late pregnancy up to five months after birth. The disease is difficult to identify and is often misdiagnosed. Multiple studies estimate that 7% to 20% of U.S. mothers who have it don’t survive.
As a nurse scientist with a research focus on maternal health equity, I wanted to learn more about the factors that cause peripartum cardiomyopathy.
My team and I examined more than 7.3 million birth records in California between 1997 and 2019. By using the neighborhood deprivation index, which measures socioeconomic disadvantage in a geographic area, we linked hospital discharge and vital records information up to 12 months postpartum follow-up on each woman. From that data, we developed a more complete picture on why women developed the illness.
We found that living in poor neighborhoods with fewer resources was associated with a 20% to 70% increased risk of developing this disease. Those in the most under-resourced neighborhoods – areas with less access to nutritious food, stable housing and quality health care – had the highest risk. This was true even after accounting for other factors, like income, race, high blood pressure and obesity.
But living in highly stressed neighborhoods explained only part of the reason for the higher rates of peripartum cardiomyopathy in Black women. We found that even if they lived in better neighborhoods, Black women were still more than three times as likely to develop the condition than others.
Why it matters
Our findings suggest deeper issues are contributing to the increase in the disease, particularly in Black women.
Barriers to health care are critical. These include insurance gaps,
transportation issues, the biases of doctors and other providers and inadequate access to care.
A better understanding of these factors can help policymakers develop effective interventions for all women at risk and reallocate resources – and dollars – to prevent disparities in maternal health outcomes.
What still isn’t known
Our study only points to neighborhood disinvestment and chronic high blood pressure as contributors to the risk of peripartum cardiomyopathy. Unanswered questions remain about the other causes.
More research is needed to fully understand how social determinants of health, which are the environmental conditions where people are born, live, work and play, affect health outcomes.
For example, these communities are often food deserts – places with limited access to healthy food and larger supermarkets. Overcrowded or poor-quality housing also contribute to stress and health problems. So does the lack of safe space for physical activity.
What’s next
My future work will focus on further identifying the key factors that influence peripartum cardiomyopathy risk, such as economic stability and the effects of environmental stressors, like pollution.
I’ll also track the long-term health of peripartum cardiomyopathy survivors to understand how social factors affect recovery. My ultimate goal is to inform policies and practices that reduce disparities and improve maternal heart health for all.
The Research Brief is a short take on interesting academic work.
