Outcomes of subsequent pregnancy in women with peripartum cardiomyopathy: a systematic review and meta-analysis

Abstract

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.

Keywords: Cardiomyopathies; Heart Failure; Meta-Analysis; Pregnancy; Systematic Reviews as Topic.

Figure 1

PRISMA flow diagram for study selection. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

Forest plot of mortality in SSP with persistent LV dysfunction and PPCM. The individual OR is shown as a solid blue box, and the pooled estimate of OR is shown as a solid black diamond. Lines show the 95% CIs. LV, systolic diamet; M-H, Mantel-Haenszel; PPCM, peripartum cardiomyopathy; SSP, subsequent pregnancy.

Figure 3

Forest plot of LVEF in SSP with persistent LV dysfunction and PPCM. The individual mean difference is shown as a solid green box, and the pooled estimate of mean difference is shown as a solid black diamond. Lines show the 95% CIs. IV, inverse variance; LV, left ventricular; LVEF, left ventricular ejection fraction; PPCM, peripartum cardiomyopathy; SSP, subsequent pregnancy.