Peripartum cardiomyopathy: Differential diagnosis and maternal prognosis

Peripartum cardiomyopathy can be mistaken for physiological pregnancy symptoms or for other causes of acute cardiopulmonary deterioration. Its diagnosis also initiates a prognostic assessment that must extend beyond the first measurement of left ventricular ejection fraction. This critical narrative review examines differential diagnosis, predictors of maternal recovery, and residual risk after apparent normalization of ventricular function. Literature searches conducted in 2026 consulted indexed clinical studies, cardiology and maternal-fetal medicine guidance, and systematic reviews addressing complications and subsequent pregnancy. The diagnosis requires otherwise unexplained systolic dysfunction in a compatible peripartum setting; hypertension, pulmonary embolism, coronary disease, myocarditis, stress cardiomyopathy, and pre-existing structural disease require targeted evaluation. Baseline ventricular impairment and remodeling help estimate recovery, but prediction models remain dependent on their derivation populations. Prospective registries show substantial improvement alongside clinically important mortality, thromboembolism, and regional differences. Recovery can continue beyond six months, and long-term cohorts document later deterioration in some women whose function initially normalized. Subsequent pregnancy carries relapse risk even after recovery, although persistent dysfunction is associated with less favorable maternal outcomes. Accurate etiological assessment, serial evaluation, appropriate treatment, and individualized reproductive counseling are essential to interpreting maternal prognosis.