• pregnancy
• heart failure with reduced ejection fraction
• familial cardiomyopathies
• idiopathic dilated cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a type of dilated cardiomyopathy (DCM) that most often develops early post partum, although PPCM can also present up to 5 months post partum or in the final month of pregnancy.1 2 PPCM is a rare disorder, occurring in approximately 1 in 1000 to 4000 pregnancies in the USA, but higher incidences are reported in areas such as Haiti and Nigeria, where between 1 in 100–300 live births are associated with PPCM.1 2

PPCM is considered a diagnosis of exclusion and is characterised by new onset heart failure with a reduced (<45%) left ventricular ejection fraction, without any other identifiable aetiology.2 The disorder shares many features with DCMs typically encountered in older patients that are not related to pregnancy.1 3 Unlike DCM, however, most women with PPCM recover heart function either fully or partially in the span of months. PPCM nonetheless remains a leading cause of cardiac transplant and maternal mortality.1 2 Thus, rapid identification of PPCM and aggressive management, when clinically appropriate, are paramount.

As the diagnosis of PPCM can be challenging, identifying women at risk may facilitate intervention at an earlier stage of disease, which is likely to be key to improving outcomes. However, this has proven historically challenging due to our limited understanding of the pathophysiology of this disorder. A major barrier is that PPCM may, in fact, encompass a group of related disorders with potentially different aetiologies,1 3 4 which is supported by observations that PPCM that presents with pre-eclampsia or other hypertensive disorders has a better prognosis than PPCM without hypertension.1

Other clinical risk factors have been identified, including advanced maternal age, multiple births, and African and Asian descent.1 2 However, most patients with these …