Psychiatric Comorbidities in Peripartum Cardiomyopathy: A Systematic Review of Prevalence, Mechanisms, and Impact on Cardiac Outcome

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Peripartum cardiomyopathy. Intervention: Psychiatric comorbidities (depression, anxiety, PTSD) vs. General postpartum population or non-peripartum heart failure patients. Primary outcome: Prevalence of psychiatric comorbidities.

Q: What does this research mean for the field?

Psychiatric comorbidities, particularly depression, anxiety, and PTSD, affect 26% to 56% of women with peripartum cardiomyopathy and are associated with poorer treatment adherence, impaired quality of life, and delayed cardiovascular recovery. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Gursabeen Kaur; Ritu Mehta; Akash Batta; Ankitdeep Kamboj; Trisha Kohli; Pankaj Kumar; Bholeshwar Prasad Mishra

doi:10.25259/ijcdw_52_2025

June 28, 2026Indian Journal of Cardiovascular Disease in WomenOpen Access

Psychiatric Comorbidities in Peripartum Cardiomyopathy: A Systematic Review of Prevalence, Mechanisms, and Impact on Cardiac Outcome

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Key result

Psychiatric comorbidities affect up to ~56% of PPCM patients and are linked to delayed recovery.

Key Points

To evaluate the prevalence, underlying biological and psychosocial mechanisms, and cardiovascular impact of psychiatric comorbidities in women with peripartum cardiomyopathy (PPCM).
Conducted a PRISMA-guided systematic review registered in PROSPERO across five electronic databases (PubMed, Scopus, Web of Science, DOAJ, and Semantic Scholar) up to February 28, 2026.
Identified 1183 records and included 10 observational, cohort, case–control, qualitative studies, and clinical trials examining psychiatric outcomes in PPCM.
Assessed risk of bias using National Institutes of Health and Joanna Briggs Institute tools and synthesized findings narratively.
Psychiatric disorders were present in 26% to 56% of women with PPCM, with depression reported in up to 56%, generalized anxiety in 53.7%, and PTSD up to 14 times more frequent than in controls.
Psychiatric comorbidity was associated with lower baseline ejection fractions, reduced therapy adherence, persistent symptoms, delayed cardiac recovery, and impaired quality of life.
Key proposed mechanisms included inflammatory cytokine activation (TNF-α, IL-6, CRP), neurohormonal dysregulation, altered tryptophan metabolism, and traumatic intensive care or delivery experiences.

Study Design

Type

Systematic Review

Structured PICO

P

Population

A systematic review of 10 studies evaluating the prevalence, mechanisms, and clinical impact of psychiatric comorbidities in women with peripartum cardiomyopathy.

O

Outcome

Prevalence, mechanisms, and cardiovascular impact of psychiatric comorbidities (depression, anxiety, and post-traumatic stress disorder) in PPCM

Psychiatric comorbidities such as depression, anxiety, and PTSD are highly prevalent (26-56%) in women with peripartum cardiomyopathy and are associated with impaired recovery and quality of life, highlighting the need for integrated multidisciplinary cardio-obstetric care.

Limitations

Only ten studies met eligibility criteria
Majority of the included studies were cross-sectional with small sample sizes
Limited longitudinal follow-up to assess long-term psychiatric trajectories
Methodological heterogeneity in assessment tools and diagnostic criteria hindered formal meta-analysis
Majority of studies originate from high-income Western countries, limiting generalizability
small sample sizes
cross-sectional designs
limited longitudinal follow-up
inconsistent diagnostic approaches
heterogeneity hindered formal meta-analysis
majority of studies from high-income Western countries

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Implication

Routine psychiatric screening may improve PPCM outcomes; confirms high comorbidity burden and supports integrated care research.

Abstract

Peripartum cardiomyopathy (PPCM) is a pregnancy-associated cardiomyopathy and an important cause of maternal cardiovascular morbidity and mortality. Emerging evidence suggests that psychiatric comorbidities may adversely affect cardiovascular rehabilitation and quality of life in women with PPCM; however, their prevalence and clinical significance remain insufficiently understood. This systematic review aimed to evaluate the prevalence, mechanisms, and cardiovascular impact of psychiatric comorbidities in PPCM. The review was registered in PROSPERO and conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Five electronic databases (PubMed, Scopus, Web of Science, DOAJ, and Semantic Scholar) were searched up to February 28, 2026. Eligible studies included observational, cohort, case–control, qualitative studies, and clinical trials reporting psychiatric outcomes in women with PPCM. Risk of bias was assessed using National Institutes of Health and Joanna Briggs Institute tools, and findings were narratively synthesized. Of 1183 records identified, 10 studies met eligibility criteria. Depression, anxiety, and post-traumatic stress disorder were the most frequently reported psychiatric conditions, with prevalence rates ranging from 26% to 56% across studies. Psychiatric morbidity was associated with poorer treatment adherence, impaired quality of life, persistent symptoms, and delayed cardiovascular recovery. Proposed mechanisms included inflammatory activation, neurohormonal dysregulation, autonomic dysfunction, and psychosocial stressors unique to the peripartum period. Psychiatric comorbidity appears to be common and clinically significant in PPCM. Early identification and integrated multidisciplinary collaboration may improve both psychological well-being and long-term cardiovascular recovery in this vulnerable population. To our knowledge, this is the first systematic review focusing exclusively on psychiatric comorbidities in PPCM.

Discussion

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Cite This Study

Kaur et al. (2026) conducted a systematic review in Peripartum cardiomyopathy. Psychiatric comorbidities (depression, anxiety, PTSD) vs. General postpartum population or non-peripartum heart failure patients was evaluated on Prevalence of psychiatric comorbidities. Psychiatric comorbidities, including depression, anxiety, and PTSD, are highly prevalent in women with peripartum cardiomyopathy and are associated with poorer treatment adherence and delayed recovery.

synapsesocial.com/papers/6a94140336938381f500e380 https://doi.org/10.25259/ijcdw_52_2025

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Psychiatric Comorbidities in Peripartum Cardiomyopathy: A Systematic Review of Prevalence, Mechanisms, and Impact on Cardiac Outcome

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Psychiatric Comorbidities in Peripartum Cardiomyopathy: A Systematic Review of Prevalence, Mechanisms, and Impact on Cardiac Outcome

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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