Key result
Recovered LVEF before subsequent pregnancy linked to ~73% lower maternal mortality but similar PPCM relapse.
Why the study?
Subsequent pregnancy in women with prior peripartum cardiomyopathy carries a risk of relapse and adverse maternal outcomes, prompting evaluation of risks stratified by baseline LVEF.
Does recovered LVEF (≥50%) prior to subsequent pregnancy reduce the risk of PPCM relapse and maternal mortality in women with prior peripartum cardiomyopathy compared to non-recovered LVEF (<50%)?
Does recovered LVEF (≥50%) prior to subsequent pregnancy reduce the risk of PPCM relapse and maternal mortality in women with prior peripartum cardiomyopathy compared to non-recovered LVEF (<50%)?
In women with prior peripartum cardiomyopathy, having a recovered LVEF before a subsequent pregnancy significantly reduces maternal mortality, but the risk of PPCM relapse remains high regardless of baseline LVEF.
Supports shared decision-making for subsequent pregnancies in women with prior PPCM; reinforces prognostic role of LVEF recovery and leaves open effective relapse prevention.
Background Subsequent pregnancy in women with prior peripartum cardiomyopathy (PPCM) carries a risk of relapse and adverse maternal outcomes. This meta-analysis aimed to determine the recurrence of PPCM relapse and associated maternal and fetal outcomes during subsequent pregnancy, stratified by baseline (pre-subsequent pregnancy) left ventricular ejection fraction (LVEF). Methods A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Nine databases were searched through June 2025 for cohort studies reporting subsequent pregnancy outcomes in women with prior PPCM, stratified as recovered (LVEF ≥50%) or non-recovered (LVEF <50%) groups. Outcomes included PPCM relapse, maternal mortality, LVEF during and after pregnancy, LV recovery, symptom worsening, and obstetric/neonatal events. Risk of bias was assessed with ROBINS-E, and random-effects models were used. Results Six cohort studies comprising 266 women were included (174 in recovered group and 92 in non-recovered group). Relapse occurred in both groups with no significant difference (rate ratio [RR] 0.77, 95% CI 0.50–1.19; I2=3%). Maternal mortality was significantly lower in the recovered group (1.7% vs 10.9%; RR 0.27, 95% CI 0.09–0.87; I2=0%). Recovered group had higher mean LVEF during subsequent pregnancy (mean difference [MD] 17.0; p<0.001), higher postpartum LVEF (MD 11.69; p=0.005; I2=84%), and greater likelihood of LV recovery (RR 2.07; p=0.005; I2=0%). No significant differences were observed in symptom worsening or obstetric/neonatal outcomes. Conclusion Recovered LVEF prior to subsequent pregnancy is associated with improved maternal outcomes, yet relapse remains common. LVEF alone is insufficient for risk stratification, and individualized multidisciplinary care is essential for all women with prior PPCM.
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Prameswari et al. (2026) studied this question. Women with recovered LVEF (≥50%) before subsequent pregnancy had significantly lower maternal mortality (1.7% vs 10.9%; RR 0.27) but similar PPCM relapse rates.
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