Author + information
- Received June 8, 2013
- Revision received July 29, 2013
- Accepted August 12, 2013
- Published online October 29, 2013.
- Natalie Bello, MD,
- Iliana S. Hurtado Rendon, MD and
- Zoltan Arany, MD, PhD∗ ()
- Cardiovascular Division and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- ↵∗Reprint requests and correspondence:
Dr. Zoltan Arany, Beth Israel Deaconess Medical Center, Cardiovascular Division and Center for Vascular Biology Research, ECLS 906, 330 Brookline Avenue, Boston, Massachusetts 02215.
Objectives The goal of this study was to systematically review the peripartum cardiomyopathy (PPCM) literature and determine the prevalence of pre-eclampsia (PE) in women with PPCM. Secondary analyses included evaluation of the prevalence of hypertensive disorders, multiple gestations, and multiparity.
Background PPCM is a significant cause of maternal and infant morbidity and mortality worldwide, yet its etiology remains unknown. PE is often cited as a risk factor for the development of PPCM and recent research suggests that PE and PPCM share mechanisms that contribute to their pathobiology. No comprehensive evaluation of the relationship between PE and PPCM exists.
Methods A systematic predetermined search strategy was performed in multiple databases to identify studies describing ≥3 women with PPCM. Prevalence rates of PE, hypertension, multiple gestations, and multiparity were pooled.
Results Data from 22 studies (n = 979) were included in this analysis. The pooled prevalence of 22% (95% confidence interval [CI]: 16% to 28%) was more than quadruple the 5% average worldwide background rate of PE in pregnancy (p < 0.001). There were no geographic or racial differences detected in the prevalence of PE in women with PPCM. The rates of hypertension during pregnancy (37% [95% CI: 29% to 45%]) and multiple gestations (9% [95% CI: 7% to 11%]) were also elevated.
Conclusions The prevalence of PE, hypertensive disorders, and multiple gestations in women with PPCM is markedly higher than that in the general population. These findings support the concept of a shared pathogenesis between PE and PPCM and highlight the need for awareness of the overlap between these 2 diseases.
Dr. Bello is supported by the National Heart, Lung, and Blood Institute (T32 5T32HL007374-33). Dr. Arany is supported by the National Heart, Lung, and Blood Institute and the Ellison Foundation (New York, New York). Dr. Rendon has reported that she has no relationships relevant to the contents of this paper to disclose.
- Received June 8, 2013.
- Revision received July 29, 2013.
- Accepted August 12, 2013.
- 2013 American College of Cardiology Foundation