Key result
Persistent LV dysfunction before subsequent pregnancy in women with prior PPCM linked to ~13-fold higher mortality.
Why the study?
The safety of subsequent pregnancy is a primary concern for women with prior peripartum cardiomyopathy, requiring better comprehension of outcomes to optimize decision-making and patient counseling.
Does subsequent pregnancy increase the risk of relapse and mortality in women with a previous history of peripartum cardiomyopathy?
Meta-Analysis (n=487)
Does subsequent pregnancy increase the risk of relapse and mortality in women with a previous history of peripartum cardiomyopathy?
Subsequent pregnancy in women with a history of peripartum cardiomyopathy carries a substantial risk of relapse and mortality, which is significantly higher in those with persistent left ventricular dysfunction prior to pregnancy.
Advise against subsequent pregnancy in peripartum cardiomyopathy survivors with persistent LV dysfunction; confirms elevated mortality risk for preconception counseling.
INTRODUCTION: The primary concern for women who have experienced peripartum cardiomyopathy (PPCM) is the safety of a subsequent pregnancy (SSP). To maximie decision-making, facilitate effective patient counselling, and ultimately improve maternal and fetal outcomes as a whole, it is critical to comprehend the outcomes of SSP in women who have previously experienced PPCM. This study aimed to evaluate the outcomes of SSP in women with PPCM. METHODS: Three databases (PubMed, Scopus, and ScienceDirect) were used to identify relevant studies prior to 17 October 2023. A total of 662 studies were reviewed. Following the abstract and full-text screenings, 18 observational studies were included, out of which 2 were deemed suitable for inclusion in this meta-analysis. The quality assessment was conducted using the Newcastle-Ottawa Scale. RESULTS: This study has a total of 487 SSPs. Although recovered left ventricular (LV) function before entering SSP has the potential to be a beneficial prognostic factor, recovered LV function still has a substantial risk of relapse. The mortality rate of PPCM in an SSP ranged from 0% to 55.5%. Persistent LV dysfunction was significantly associated with an increased mortality rate (OR 13.17; 95% CI 1.54 to 112.28; p=0.02) and lower LV ejection fraction (MD -12.88; 95% CI -21.67 to -4.09; p=0.004). Diastolic and right ventricular functions remained unchanged before SSP and at follow-up. The majority of the SSP was observed alongside hypertension, while pre-eclampsia emerged as the predominant hypertensive complication in most studies. CONCLUSION: SSP increases the risk of relapse and mortality in women with a previous history of PPCM. Persistent LV dysfunction prior to the SSP has a higher mortality risk compared with recovered LV function. SSP was also associated with the worsening of LV echocardiography parameters.
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Wijayanto et al. (2024) conducted a meta-analysis in Peripartum cardiomyopathy (PPCM) (n=487). Persistent LV dysfunction prior to subsequent pregnancy vs. Recovered LV function was evaluated on Mortality rate (OR 13.17, 95% CI 1.54-112.28, p=0.02). In women with previous peripartum cardiomyopathy, persistent LV dysfunction prior to a subsequent pregnancy was associated with significantly increased mortality (OR 13.17; 95% CI 1.54-112.28; p=0.02).
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