Association of Peripartum Cardiomyopathy with Preeclampsia and Maternal Outcomes

Open Access

Abstract

Background: Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening form of heart failure occurring in late pregnancy or the early postpartum period. Preeclampsia has been implicated as a risk factor for more severe cardiac dysfunction and adverse maternal outcomes in PPCM, but data on its impact in South Asian populations remain limited. Aim of the study: To evaluate the prevalence and characteristics of preeclampsia among women with PPCM and to investigate its association with cardiac dysfunction and maternal outcomes. Methods & Materials: This observational study included 150 women diagnosed with PPCM caried outat the Department of Fetomatanal Medicine, Bnagladesh Medical University, Dhaka, Bangladesh from January 2024 to December 2025. Demographic, obstetric, clinical, and echocardiographic data were collected. Preeclampsia was defined according to international criteria and categorized by severity and timing of onset. Maternal outcomes were monitored during hospitalization and at six months follow-up, with left ventricular function recovery classified as complete (LVEF ≥50%), partial (LVEF 35-49%), or persistent dysfunction (LVEF <35%). Multivariable logistic regression identified predictors of adverse maternal outcomes. Result: The mean maternal age was 31.8 ± 5.4 years, and 60% were multigravida. PPCM was predominantly diagnosed postpartum (63.3%) at 36.2 ± 3.1 weeks, with cesarean delivery in 58.7% of cases. Preeclampsia occurred in 33.3% of women, including 20% with severe disease. Mean LVEF at diagnosis was 36.8 ± 6.2%, with 40% presenting LVEF <35%. Patients with preeclampsia had significantly lower LVEF (34.2 ± 5.5% vs. 37.7 ± 6.1%, p=0.002) and higher NYHA class III-IV prevalence (44% vs. 28%, p=0.03). Acute heart failure was the most common maternal complication (68%), with maternal mortality of 5.3%. Multivariable analysis identified preeclampsia (AOR 2.45, p=0.024), severe preeclampsia (AOR 3.12, p=0.008), LVEF <35% (AOR 4.78, p<0.001), and NYHA class III-IV (AOR 3.65, p=0.004) as independent predictors of adverse outcomes. At six months, 45.3% achieved complete recovery, 38.7% partial recovery, and 14.7% had persistent LV dysfunction. Conclusion: Preeclampsia significantly exacerbates cardiac dysfunction in PPCM and is associated with increased risk of adverse maternal outcomes. Early recognition, echocardiographic assessment, and intensive management are crucial for improving maternal prognosis and left ventricular recovery.