Association between multiple pregnancy with peripartum cardiomyopathy: a systematic review and meta-analysis.

BACKGROUND

While the diagnostic criteria for peripartum cardiomyopathy (PPCM) have been better established than other forms of cardiomyopathies in pregnancy, its pathogenesis and association with multiple pregnancies are still poorly understood, and there has never been an established meta-analysis regarding this study. Therefore, this study aims to evaluate the association between multiple pregnancies and the development of PPCM.

METHODS

We conducted a comprehensive literature search using several databases, including PubMed, Scopus, and ScienceDirect, until May 31th, 2025. Studies were eligible if they investigated the association between multiple pregnancies and the probability of PPCM. Data were analyzed using a random effects model of pooled odds ratios (ORs) with the Mantel-Haenszel method.

RESULTS

This meta-analysis included one prospective and ten retrospective observational studies, with a total of 11,523,332 participants from eight different countries. Our study revealed that multiple pregnancies were significantly associated with an increased risk of developing PPCM (OR = 2.59 (95% CI = 2.17-3.10); P = < 0.00001; I2 = 36%, P-heterogeneity = 0.03).

CONCLUSION

Multiple pregnancies demonstrated a significant association with the risk of PPCM development; hence, screening in this high-risk group is required.