Peripartum cardiomyopathy (PPCM) is a rare but serious form of heart failure that can affect women late in pregnancy or shortly after giving birth. According to Liviu Cojocaru, M.D., an obstetrician specializing in maternal-fetal and critical care medicine at the University of Miami Health System, PPCM “is a rare form of heart failure occurring in women without prior heart disease, usually during the last month of pregnancy or up to five months postpartum.”
Symptoms such as fatigue, shortness of breath, and swelling in the feet and legs often resemble normal pregnancy discomforts. This similarity can result in delayed or missed diagnoses, which may be fatal.
The condition impacts about 1 in every 1,000 to 4,000 live births worldwide. The global prevalence varies widely depending on geographic location.
PPCM involves systolic dysfunction with enlargement of the heart chambers and weakening of the heart muscle. This reduces how much blood the heart pumps with each beat. Early diagnosis and treatment are important for improving outcomes. Dr. Cojocaru states: “Delayed diagnosis of PPCM can result in persistent heart failure, abnormal heart rhythms (arrhythmias), or even death.”
Mortality rates associated with PPCM range from 2% to as high as 56% depending on the population studied. In severe cases, survivors may not fully recover and could require a heart transplant.
The underlying causes remain unclear. However, studies suggest several factors may contribute to its development—including hypertensive disorders like preeclampsia—while some research links higher levels of certain hormones and proteins to cardiac dysfunction. Additional possible contributors include nutritional deficiencies, immune system abnormalities, previous viral illness, and hemodynamic stress during pregnancy according to findings summarized by the American Heart Association.
“No single, unified cause for peripartum cardiomyopathy has been identified,” says Dr. Cojocaru. “However, researchers have identified multiple factors that increase risk.”
Risk factors include advanced maternal age, multiple pregnancies (such as twins), diabetes, obesity, hypertension developed during pregnancy, genetic predispositions—about 10% to 20% of women with PPCM have genetic mutations related to cardiomyopathies—and being Black; though why race plays a role is still not understood.
Diagnosis typically relies on an echocardiogram measuring ejection fraction (EF). A value below 45% suggests PPCM; normal EF ranges from 50% to 70%. Blood tests are also used for further assessment.
Dr. Cojocaru advises vigilance regarding symptoms: “Women should watch for unusual fatigue, prominent ankle swelling, rapid heartbeat or palpitations, persistent cough and shortness of breath especially at rest or while lying flat,” he says. “Prompt medical evaluation is critical if these symptoms develop.”
Treatment follows standard protocols for heart failure but is adjusted for breastfeeding mothers when necessary. With proper management—including medications and lifestyle changes—between half and four-fifths of affected women see significant improvement within six to twelve months; those with lower initial function or certain genetic risks tend to recover less well.
“The primary goal of treatment is to relieve heart failure symptoms, improve cardiac function, and prevent serious complications,” Dr. Cojocaru adds. “Treatment usually involves a comprehensive multidisciplinary approach that includes medications lifestyle modifications and in some severe cases advanced interventions.”
Recent studies highlight risk factors such as hypertensive disorders during pregnancy—including preeclampsia—as increasing the likelihood of developing PPCM (source).
