Incidence, characteristics and long-term outcomes of peripartum cardiomyopathy: Insights from the Bergen peripartum cardiomyopathy study

Abstract

Background

Peripartum cardiomyopathy (PPCM) is a rare but potentially fatal condition characterized by heart failure occurring at the end of pregnancy or within the first months after delivery in women without prior history of structural heart disease. This single-center case-control study aimed to describe the incidence, clinical profile, echocardiographic findings and outcomes of PPCM in a West-Norwegian population.

Methods

Between 2011 and 2023, a total of 15 cases of PPCM were identified at Haukeland University Hospital. The Bergen Birth Registry was used to determine the total number of births in the same period, and to recruit 30 age-matched healthy controls. Clinical characteristics, echocardiographic data, and outcomes were collected.

Results

The incidence rate of PPCM was 1 in 4,182 births. Risk factors included higher pre-pregnancy body mass index (BMI) (OR 1.25) and elevated systolic blood pressure at presentation (OR 1.11). The prevalence of pre-eclampsia and primiparity was significantly higher in PPCM patients compared to controls (p < 0.01). Mean left ventricular (LV) ejection fraction increased from 35% at presentation to 58% at the 6-month follow-up (p < 0.001). There were no maternal or neonatal mortalities. Three patients required ICU treatment, but none experienced major cardiovascular events.

Conclusions

The incidence of PPCM in this West-Norwegian study was relatively low. Higher pre-pregnancy BMI and elevated systolic blood pressure, both important modifiable cardiovascular risk factors, were identified as predictors of PPCM. All patients experienced successful clinical and LV function recovery. Future large collaborative studies are necessary to provide a reliable description of incidence and outcomes nationwide.