Abstract
Background
Peripartum cardiomyopathy (PPCM) is a disorder of unknown aetiology in which heart
failure due to left ventricular dysfunction occurs between the last month of pregnancy
and first five months post-partum. Theories abound concerning the specific cause and
risk factors for PPCM, but none have been accepted universally. The primary objective
of this review was to summarize the state of knowledge on the pathogenesis of PPCM,
especially in light of recent studies.
Methods
We searched MEDLINE (January 1966–September 2007), OVID, and reference lists of articles
for studies containing information on the aetiology and risk factors for PPCM, and
published in English.
Results
The literature reveals a wealth of articles proposing various mechanisms for aetiology
and risk factors of PPCM. There is conflicting evidence on the pathogenetic role of
viral myocarditis, abnormal immune response to pregnancy, abnormal response to the
haemodynamic stress of pregnancy, accelerated myocyte apoptosis, cytokine-induced
inflammation, malnutrition, genetic factors, excessive prolactin production, abnormal
hormonal function, increased adrenergic tone, and myocardial ischaemia. A number of
factors are postulated to increase the risk of the development of PPCM. These include
non-Caucasian ethnicity, advanced maternal age, multiparity, poor socioeconomic status,
multiple pregnancy and prolonged tocolytic use. The authors call for a strict definition
of PPCM that excludes known causes of heart failure, such as the pregnancy-induced
hypertensive spectrum of disorders.
Conclusion
The aetiology and risk factors for PPCM are poorly defined. There is a need for large-scale
multi-centre epidemiological studies and registries to delineate the aetiology and
pathogenesis of PPCM.
Keywords
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Article info
Publication history
Published online: August 26, 2008
Accepted:
June 28,
2008
Received in revised form:
May 29,
2008
Received:
September 24,
2007
Footnotes
☆The authors of this article are funded in part by research grants from the University of Cape Town, Medical Research Council of South Africa, the National Research Foundation, and the Wellcome Trust (UK).
Identification
Copyright
© 2008 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
