Peripartum Cardiomyopathy: Global Incidence, Risk Factors, and Long-Term Outcomes

Abstract

Introduction: Peripartum cardiomyopathy (PPCM) is a life-threatening cause of heart failure occurring late in pregnancy or early postpartum. Reported incidence varies widely by geography, and long-term recovery data are sparse.
Methods: A systematic literature review of population-based studies and registries (1990–2023) from Africa, Asia, Europe, and the Americas. Inclusion: defined by ESC or NHLBI criteria. Exclusion: pre-existing cardiomyopathy. Outcomes: incidence per live births, recovery (LVEF ≥50% at 6 months), mortality.
Results: 37 studies (n=14,200 women) included. Global incidence ranged from 1:300 (Nigeria) to 1:10,000 (Northern Europe). Highest incidence in Haiti (1:299) and South Africa (1:1,000). Risk factors: preeclampsia (OR 3.9), twin pregnancy (OR 4.2), advanced maternal age, and prolonged tocolysis. Six-month recovery occurred in 52% (95%CI 47–57%), ranging 36% in Egypt to 68% in Sweden. Mortality at 1 year: 8.2% overall, 17% in low-income countries.
Discussion: Genetic predisposition (e.g., TTN truncating variants) and oxidative stress (cleavage of prolactin) are postulated mechanisms. Disparities reflect differences in healthcare access, diagnostic awareness, and socioeconomic factors. Data on long-term outcomes (≥5 years) are limited, especially in Africa.
Conclusions: PPCM incidence is markedly higher in sub-Saharan Africa and Haiti. Recovery is suboptimal in half of patients. Standardized protocols including bromocriptine and evidence-based HF therapy should be globally implemented.