Risk Factors for Peripartum Cardiomyopathy: A Systematic Review and Meta-Analysis

Abstract

Background

Peripartum cardiomyopathy (PPCM) refers to heart failure following the last month of gestation or within 5 months postpartum, which is a major cause of pregnancy-related death. However, the risk factors for PPCM remain unclear. Therefore, this meta-analysis aimed to identify the risk factors for PPCM.

Method

All studies on risk factors for PPCM published up to April 2024 in Embase, PubMed, the Cochrane Library, and Web of Science were systematically searched. The quality of the included studies was assessed with the Newcastle–Ottawa scale (NOS).

Results

Eighteen studies involving 203,374,478 participants were included. It was found that obesity (OR 1.43, 95% CI 1.24–1.65; p<0.001), parity (OR 1.79, 95% CI 1.21–2.67; p=0.004), gestational hypertension (OR 2.00, 95% CI 1.35–2.95; p=0.001), diabetes (OR 1.33, 95% CI 1.06–1.68; p=0.015), and pre-eclampsia (OR 3.28, 95% CI 1.64–6.55; p=0.001) all raised the PPCM risk. Smoking had no statistical association with the development of PPCM (OR 0.97, 95% CI 0.57–1.65; p=0.903). The PPCM risk tended to rise in multiple pregnancies (OR 1.82, 95% CI 0.97–3.43; p=0.063).

Conclusions

This study demonstrated that obesity, multiparity, gestational hypertension, diabetes, and pre-eclampsia are risk factors for PPCM. Smoking is not associated with the development of PPCM, and the PPCM risk tends to rise in multiple pregnancies. Caesarean section and acute kidney injury are common in pregnant women and their association with PPCM needs to be interpreted with caution. Understanding the risk factors for PPCM can provide medical workers with a theoretical basis for patient management and treatment.