Association of Hypertensive Disorders of Pregnancy and their Clinical Features with Peripartum Cardiomyopathy: A Systematic Review and Meta-analysis

Background: Peripartum Cardiomyopathy (PPCM) is a rare yet fatal cardiac disease associated with pregnancy. PPCM has been shown to have similar etiopathogenesis with hypertensive disorders of pregnancy (HDP). Hence, this study aims to study the association between HDP and the development of PPCM. Methods: Three databases (PubMed, Scopus, Cochrane Library) were searched and screened based on prespecified inclusion and exclusion criteria. Predictors of PPCM evaluated were HDP (preeclampsia, superimposed preeclampsia, chronic hypertension, and gestational hypertension) and its clinical features (severe preeclampsia, age, parity, serum creatinine, etc.). Data were analyzed using the random effects model of pooled odds ratios (ORs) with the Mantel Haenszel method, and publication bias was assessed with a funnel plot. Results: A total of 13 observational studies with 11,951 PPCM cases from 7 countries were identified. All types of HDP were associated with significantly increased odds of developing PPCM, and severe preeclampsia was associated with the highest OR of 13.33 (CI: 5.95 – 29.83, p < 0.01). Additionally, superimposed preeclampsia, chronic hypertension, preeclampsia, and lastly gestational hypertension were associated with increased odds of PPCM with OR 5.77, 4.73, 4.70, and 3.13, respectively. Other clinical features being statistically significant for PPCM development included advanced age > 35 years and multiple pregnancies (p < 0.05). No significant difference in creatinine level was found between PPCM and no PPCM group. No publication bias was found based on funnel plot assessment. Conclusion: HDP, especially severe preeclampsia, is associated with increased odds of PPCM development; hence, a low threshold for PPCM screening in this high-risk group is required.