Diagnosis and management of peripartum cardiomyopathy and recurrence risk

Peripartum cardiomyopathy (PPCM) is a rare, but serious condition, with a non-negligible risk of adverse events. Several risk factors for PPCM have been individuated over the years, including Afro-American ethnicity, preeclampsia, advanced maternal age, genetic predisposition, multiparity, twin pregnancy, obesity, smoking and diabetes. However, PPCM pathophysiology is still poorly understood, thus making it challenging to develop disease specific therapies. At present, Bromocriptine is the only targeted drug, but further evidence is needed to establish indication and timing of administration. Therefore, these patients are mainly treated following general heart failure guidelines. Even though in most patients left ventricular ejection fraction recovers during follow-up, cases of persistent left ventricular dysfunction are not uncommon. Moreover, all patients detain a certain risk of recurrence after subsequent pregnancies, which is difficult to estimate due to the dearth of long-term prospective data. In this manuscript, we aim to provide an updated review of current evidence about PPCM pathophysiology, diagnosis, treatment and recurrence risk. In addition, we discuss the gaps in knowledge that should be addressed by future research.