Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2013 Oct 29;62(18):1715-1723.
doi: 10.1016/j.jacc.2013.08.717. Epub 2013 Sep 4.

The relationship between pre-eclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis

Natalie Bello  1 , Iliana S Hurtado Rendon  1 , Zoltan Arany  2
Affiliations
Meta-Analysis

The relationship between pre-eclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis

Natalie Bello et al. J Am Coll Cardiol. .

Abstract

Objectives: The goal of this study was to systematically review the peripartum cardiomyopathy (PPCM) literature and determine the prevalence of pre-eclampsia (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 (n = 979) 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.

Keywords: CI; LVEF; PE; PPCM; antiangiogenic; confidence interval; left ventricular ejection fraction; peripartum cardiomyopathy; pre-eclampsia; preeclampsia; sVEGFR1; soluble vascular endothelial growth factor receptor-1.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Process of Study Selection
HTN = hypertension; PE = preeclampsia; PPCM = peripartum cardiomyopathy.
Figure 2
Figure 2. Prevalence Estimates for PE in Women With PPCM
Results of the meta-analysis of the primary outcome (mean prevalence and 95% confidence interval [CI] of PE in women with PPCM). The red line represents the background worldwide prevalence rate of 5%. *Reported rate 0%; 5% used for statistical purposes. Abbreviations as in Figure 1.
Figure 3
Figure 3. Prevalence Estimates for PE in Women With PPCM According to Country
Data are given as United States versus non–United States. Results of the meta-analysis stratified according to study country (mean prevalence and 95% CI of PE in women with PPCM). The red line represents the background worldwide prevalence rate of 5%. *Reported rate 0%; 5% used for statistical purposes. Abbreviations as in Figures 1 and 2.
Figure 4
Figure 4. Rates of PE as a Function of Prevalence of African Heritage
Rate of PE as a function of prevalence of African heritage. Abbreviation as in Figure 1.
See this image and copyright information in PMC

References

    1. Elkayam U. Clinical characteristics of peripartum cardiomyopathy in the United States: diagnosis, prognosis, and management. J Am Coll Cardiol. 2012;58:659–70. - PubMed
    1. Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet. 2006;368:687–93. - PubMed
    1. Deneux-Tharaux C, Berg C, Bouvier-Colle MH, et al. Underreporting of pregnancy-related mortality in the United States and Europe. Obstet Gynecol. 2005;106:684–92. - PubMed
    1. Brar SS, Khan SS, Sandhu GK, et al. Incidence, mortality, and racial differences in peripartum cardiomyopathy. Am J Cardiol. 2007;100:302–4. - PubMed
    1. Fett JD, Christie LG, Carraway RD, Murphy JG. Five-year prospective study of the incidence and prognosis of peripartum cardiomyopathy at a single institution. Mayo Clin Proc. 2005;80:1602–6. - PubMed

Publication types