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Review
. 2025 Mar 4;14(5):1721.
doi: 10.3390/jcm14051721.

Hypertensive Disorders of Pregnancy and Peripartum Cardiomyopathy: A Meta-Analysis of Prevalence and Impact on Left Ventricular Function and Mortality

Aleksandar Biljic-Erski  1 , Nina Rajovic  1 , Vedrana Pavlovic  1 , Zoran Bukumiric  1 , Aleksandar Rakic  2 , Marija Rovcanin  2 , Jelena Stulic  2   3 , Radomir Anicic  2   3 , Jovana Kocic  2   3 , Jelena Cumic  3   4 , Ksenija Markovic  1 , Dimitrije Zdravkovic  3 , Dejana Stanisavljevic  1 , Srdjan Masic  5 , Natasa Milic  1   6 , Dejan Dimitrijevic  2   3
Affiliations
Review

Hypertensive Disorders of Pregnancy and Peripartum Cardiomyopathy: A Meta-Analysis of Prevalence and Impact on Left Ventricular Function and Mortality

Aleksandar Biljic-Erski et al. J Clin Med. .

Abstract

Background: The purpose of this meta-analysis was to examine the prevalence of hypertensive disorders of pregnancy (HDPs), particularly preeclampsia (PE), in peripartum cardiomyopathy (PPCM)-affected pregnancies, and to evaluate whether a HDP significantly alters the prognosis of PPCM, with specific reference to the recovery of left ventricular function (LVEF) and mortality. Methods: A total of 5468 potentially eligible studies were identified, and 104 were included in the meta-analysis. For pooling proportions, the inverse variance methods with logit transformation were used. Complete recovery of LVEF (>50%) and mortality were expressed by odds ratios (ORs), with 95% confidence intervals (CIs). The Peto OR (POR) was used in cases of rare events. Baseline LV function and baseline LV end-diastolic diameter (LVEDD) were summarized by the mean difference (MD) and 95% confidence interval (CI). Results: The summary estimate of the prevalence of HDPs and PE in women with PPCM was 36% and 25%, respectively. Patients with HDPs and, more specifically, PE with PPCM had a higher chance of complete recovery (OR = 1.87; 95%CI = 1.64 to 2.13; p < 0.001 and OR = 1.98; 95%CI 1.69 to 2.32; p < 0.001, respectively), a higher baseline LVEF (MD, 1.42; 95% CI 0.16 to 2.67; p = 0.03 and MD, 1.69; 95% CI 0.21 to 3.18; p = 0.03, respectively), and a smaller baseline LVEDD (MD, -1.31; 95% CI -2.50 to -0.13; p = 0.03 and MD, -2.63; 95% CI -3.75 to -1.51; p < 0.001, respectively). These results, however, did not translate into a significant difference in 12-month mortality (POR = 0.80; 95% CI = 0.57 to 1.13; p = 0.21 and POR = 1.56; 95% CI 0.90 to 2.73; p = 0.12, respectively). Conclusions: The findings of this study may contribute to evidence that can be utilized to aid in the risk stratification of patients with PPCM regarding their long-term prognoses.

Keywords: hypertensive disorder; meta-analysis; peripartum cardiomyopathy; preeclampsia; pregnancy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of study selection process.
Figure 2
Figure 2
Prevalence estimates for HDPs in women with PPCM.
Figure 3
Figure 3
Prevalence estimates for PE in women with PPCM.
Figure 4
Figure 4
Forest plot comparing the baseline left ventricular ejection fraction (LVEF) between patients with and without (a) HDPs and (b) PE.
Figure 5
Figure 5
Forest plot comparing the baseline left ventricular end-diastolic diameter (LVEDD) between women with and without (a) HDPs and (b) PE.
Figure 5
Figure 5
Forest plot comparing the baseline left ventricular end-diastolic diameter (LVEDD) between women with and without (a) HDPs and (b) PE.
Figure 6
Figure 6
Forest plot comparing mortality between women with and without (a) HDPs and (b) PE.
Figure 6
Figure 6
Forest plot comparing mortality between women with and without (a) HDPs and (b) PE.
Figure 7
Figure 7
Forest plot comparing the complete recovery of LVEF (>50%) between women with and without (a) HDPs and (b) PE (Shah et al. 2018 reported data for readmission).
See this image and copyright information in PMC

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