The Relationship Between Pre-Eclampsia and Peripartum Cardiomyopathy

Objectives The goal of this study was to systematically review the peripartum cardiomyopathy (PPCM) literature and determine the prevalence of preeclampsia (PE) in women with PPCM. Secondary analyses included evaluation of the prevalence of hypertensive disorders, multiple gestations, and multiparity. Background PPCM is a significant cause of maternal and infant morbidity and mortality worldwide, yet its etiology remains unknown. PE is often cited as a risk factor for the development of PPCM, and recent research suggests that PE and PPCM share mechanisms that contribute to their pathobiology. No comprehensive evaluation of the relationship between PE and PPCM exists. Methods A systematic predetermined search strategy was performed in multiple databases to identify studies describing ≥3 women with PPCM. Prevalence rates of PE, hypertension, multiple gestations, and multiparity were pooled. Results Data from 22 studies (979 patients) were included in this analysis. The pooled prevalence of 22% (95% confidence interval CI 16 to 28) was more than quadruple the 5% average worldwide background rate of PE in pregnancy (p < 0.001). There were no geographic or racial differences detected in the prevalence of PE in women with PPCM. The rates of hypertension during pregnancy (37% 95% CI 29 to 45) and multiple gestations (9% [95% CI 7 to 11) were also elevated. Conclusions The prevalence of PE, hypertensive disorders, and multiple gestations in women with PPCM is markedly higher than that in the general population. These findings support the concept of a shared pathogenesis between PE and PPCM and highlight the need for awareness of the overlap between these 2 diseases.