Recurrence of peripartum cardiomyopathy in subsequent pregnancy stratified by left ventricular function: a systematic review and meta-analysis.

Hawani Sasmaya Prameswari; Cindya Perthy Iswandi; Jordan Budiono; Melawati Hasan; Dian Yaniarti Hasanah; Triwedya Indra Dewi; Johann Bauersachs; Karen Sliwa; Peter van der Meer

doi:10.1093/ejhf/xuag063

PubMed · 41795865

Recurrence of peripartum cardiomyopathy in subsequent pregnancy stratified by left ventricular function: a systematic review and meta-analysis.

Hawani Sasmaya Prameswari·Cindya Perthy Iswandi·Jordan Budiono·Melawati Hasan·Dian Yaniarti Hasanah·Triwedya Indra Dewi·Johann Bauersachs·Karen Sliwa·Peter van der Meer

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Abstract

AIMS: Subsequent pregnancy in women with prior peripartum cardiomyopathy (PPCM) carries a risk of relapse and adverse maternal outcomes. This meta-analysis aimed to determine the recurrence of PPCM relapse and associated maternal and foetal outcomes during subsequent pregnancy, stratified by baseline (pre-subsequent pregnancy) left ventricular ejection fraction (LVEF). METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Nine databases were searched through June 2025 for cohort studies reporting subsequent pregnancy outcomes in women with prior PPCM, stratified as recovered (LVEF ≥50%) or non-recovered (LVEF <50%) groups. Outcomes included PPCM relapse, maternal mortality, LVEF during and after pregnancy, LV recovery, symptom worsening, and obstetric/neonatal events. Risk of bias was assessed with ROBINS-E, and random-effects models were used. RESULTS: Six cohort studies comprising 266 women were included (174 in recovered group and 92 in non-recovered group). Relapse occurred in both groups with no significant difference [rate ratio (RR) 0.77, 95% CI 0.50-1.19; I2 = 3%]. Maternal mortality was significantly lower in the recovered group (1.7% vs 10.9%; RR 0.27, 95% CI 0.09-0.87; I2 = 0%). Recovered group had higher mean LVEF during subsequent pregnancy (mean difference [MD] 17.0; P < .001), higher postpartum LVEF (MD 11.69; P = .005; I2 = 84%), and greater likelihood of LV recovery (RR 2.07; P = .005; I2 = 0%). No significant differences were observed in symptom worsening or obstetric/neonatal outcomes. CONCLUSION: Recovered LVEF prior to subsequent pregnancy is associated with improved maternal outcomes, yet relapse remains common. Left ventricular ejection fraction alone is insufficient for risk stratification, and individualized multidisciplinary care is essential for all women with prior PPCM.

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Female Humans Peripartum Cardiomyopathy Pregnancy Ventricular Function, Left Recurrence Stroke Volume Pregnancy Complications, Cardiovascular Pregnancy Outcome Peripartum Period Cardiomyopathies Cardiomyopathy Maternal death Peripartum cardiomyopathy Journal Article Systematic Review Meta-Analysis

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Hawani Sasmaya Prameswari, Cindya Perthy Iswandi, Jordan Budiono, Melawati Hasan, Dian Yaniarti Hasanah, Triwedya Indra Dewi, Johann Bauersachs, Karen Sliwa, Peter van der Meer. 2026-09-15. Recurrence of peripartum cardiomyopathy in subsequent pregnancy stratified by left ventricular function: a systematic review and meta-analysis.. https://doi.org/10.1093/ejhf%2Fxuag063

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Female subject Humans subject Journal Article subject Journal Article; Systematic Review; Meta-Analysis resource Meta-Analysis subject Pregnancy subject Pregnancy Complications, Cardiovascular subject Pregnancy Outcome subject Systematic reviews study

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