Postpartum Cardiomyopathy in Uganda: A Mini-Review of Current Evidence and Challenges

David Peter; Mohamed Jayte

doi:10.20944/preprints202507.2069.v1

Submitted:

17 July 2025

Posted:

24 July 2025

You are already at the latest version

Abstract

Postpartum cardiomyopathy (PPCM) is a rare but life-threatening condition that develops in the last month of pregnancy or within five months after delivery, without preexisting heart disease. Its prevalence and outcomes in Uganda remain poorly understood.This mini-review consolidates current knowledge on PPCM in Uganda, focusing on clinical features, diagnostic difficulties, treatment strategies, and patient outcomes while highlighting research gaps. A narrative review was performed using PubMed, African Journals Online (AJOL), and Google Scholar, analyzing relevant articles from 2000 to 2024, with emphasis on Ugandan and East African studies.Available data indicate that PPCM in Uganda primarily affects young, multiparous women. Frequent symptoms include dyspnea, orthopnea, and fatigue, with echocardiography typically revealing reduced left ventricular ejection fraction. Diagnostic challenges arise from symptom overlap with normal peripartum changes and limited awareness. Treatment often involves diuretics, beta-blockers, ACE inhibitors/ARBs, and bromocriptine, though evidence on SGLT2 inhibitors remains scarce. High mortality and readmission rates persist due to late diagnosis, inadequate follow-up, and limited access to advanced care.PPCM in Uganda is underrecognized and underreported. Enhancing diagnostic tools, implementing early echocardiographic screening, and creating national registries are essential. Multidisciplinary management and public awareness are critical for improving patient outcomes.

Keywords:

postpartum cardiomyopathy

;

clinical features

;

Uganda

;

Africa

;

review

Subject:

Public Health and Healthcare - Primary Health Care

Introduction

Postpartum cardiomyopathy (PPCM) is an idiopathic form of heart failure with reduced ejection fraction (HFrEF), occurring toward the end of pregnancy or in the months following delivery, in previously healthy women (1). The global incidence ranges from 1 in 1,000 to 1 in 4,000 live births (8), but studies from Nigeria and South Africa suggest a much higher prevalence in African populations (2,9).

Uganda faces unique challenges in maternal health, with cardiovascular conditions being an emerging cause of maternal morbidity and mortality (10). PPCM often goes undiagnosed due to limited echocardiography access and the non-specific nature of early symptoms, which can mimic normal postpartum fatigue (3,11). Understanding the epidemiology, presentation, and management of PPCM in Uganda is essential to inform clinical practice and public health policy.

Results

Epidemiology and Risk Factors in Uganda

Postpartum cardiomyopathy (PPCM) in Uganda has been documented primarily through hospital-based case reports and small observational studies. The condition predominantly affects young multiparous women between the ages of 20 and 35. Several risk factors contribute to its development, including high parity, delayed medical presentation, and comorbidities such as pre-eclampsia or gestational hypertension. Additionally, nutritional deficiencies and rural residence—where access to specialized healthcare is limited—further exacerbate the risk of PPCM.

Clinical Presentation

Patients typically develop symptoms within days to weeks after delivery, with the most common manifestations being severe dyspnea (often classified as NYHA class III–IV), orthopnea, and paroxysmal nocturnal dyspnea. Other frequent symptoms include persistent fatigue, peripheral edema, palpitations, and occasional chest discomfort. These clinical features often mimic other peripartum complications, leading to potential misdiagnosis or delayed recognition of PPCM.

Diagnostic Findings

Echocardiography serves as the gold standard for diagnosing PPCM, with key findings including a reduced left ventricular ejection fraction (LVEF) below 45%, left ventricular dilation, and global hypokinesia. Secondary mitral regurgitation is also commonly observed. Despite the critical role of echocardiography, diagnostic challenges persist due to limited availability of imaging equipment in many Ugandan healthcare facilities, particularly in rural areas.

Treatment Approaches in Uganda

The management of PPCM in Uganda follows a combination of pharmacological therapies aimed at stabilizing cardiac function and relieving symptoms. Diuretics are frequently used to manage fluid overload, while beta-blockers such as carvedilol are administered to improve survival outcomes. ACE inhibitors or ARBs are introduced postpartum to support cardiac remodeling. Bromocriptine, which suppresses prolactin—a potential contributor to PPCM pathogenesis—is increasingly utilized, though its accessibility remains inconsistent. Emerging treatments such as SGLT2 inhibitors (e.g., dapagliflozin) show promise but are not yet widely adopted in Ugandan clinical practice.

Outcomes

The prognosis of PPCM in Uganda varies, with some patients experiencing partial or complete recovery of left ventricular function within six months of diagnosis. However, a significant proportion face persistent morbidity, including chronic heart failure. Recurrent pregnancies substantially increase the risk of relapse, further complicating long-term outcomes. Mortality data remain poorly defined due to the absence of robust national surveillance systems, but delayed diagnosis and limited access to specialized care likely contribute to higher fatality rates. The lack of structured follow-up programs also hinders comprehensive assessment of recovery and survival trends among Ugandan PPCM patients.

Discussion

PPCM is a major cause of maternal heart failure in sub-Saharan Africa (2,3). Ugandan data are scarce, relying primarily on case series and single-center reports (6,12). Delays in diagnosis and treatment remain common due to lack of specialized cardiology services and overlap of symptoms with normal postpartum changes (11,18).

The high maternal mortality in Uganda due to cardiovascular disease may partly reflect unrecognized PPCM (10). While echocardiography is crucial for diagnosis, access remains limited outside referral hospitals (6). Moreover, awareness among frontline healthcare workers is low, contributing to underreporting (3,7).

Bromocriptine, though promising, is not widely available. There is a need for affordable medications and long-term follow-up. Emerging therapies like SGLT2 inhibitors have shown benefit in heart failure with reduced ejection fraction, but their role in PPCM in African populations is not yet defined (5,16).

Conclusion

Postpartum cardiomyopathy in Uganda remains underdiagnosed, underreported, and undertreated. Improved awareness, routine postpartum cardiac screening for high-risk women, and access to echocardiography can enhance early detection. National guidelines and a PPCM registry are urgently needed. Further research is required to determine true incidence, evaluate therapeutic strategies, and improve maternal outcomes in Uganda.

Funding

This research was not funded by any specific grant from public or non-Profit organizations.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Declaration of Helsinki

The study complies with Helsinki declaration

Consent for publication

Not Applicable

References

Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the ESC. Eur J Heart Fail. 2010 Aug;12(8):767-78.
Jayte, M. Quality of chronic disease (diabetes & hypertension) care in health care facilities in high disease burden areas in Sidama Region: cross-sectional study [Letter]. J Multidiscip Healthc. 2024 Mar 4;17:981-2.
Ntusi NB, Mayosi BM. Aetiology and risk factors of peripartum cardiomyopathy: a systematic review. Int J Cardiol. 2009 Feb 6;131(2):168-79.
Amos AM, Jaber WA, Russell SD. Improved outcomes in peripartum cardiomyopathy with contemporary. Am Heart J. 2006 Sep;152(3):509-13.
Seferovic PM, Ponikowski P, Anker SD, Bauersachs J, Chioncel O, Cleland JGF, et al. Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the ESC. Eur J Heart Fail. 2019 Oct;21(10):1169-86.
Nambiema A, Tornui J, Natukunda H. Postpartum cardiomyopathy in a tertiary hospital in Kampala, Uganda: a 5-year retrospective review. Afr Health Sci. 2021 Mar;21(1):129-36.
Jayte M, Mohamud A, Dubad F. Postpartum cardiomyopathy with congestive heart failure: A case report. SAGE Open Med Case Rep. 2024 Jun 22;12:2050313X241263761.
Elkayam U, Akhter MW, Singh H, Khan S, Bitar F, Hameed A, et al. Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation. 2005 Apr 26;111(16):2050-5.
Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet. 2006 Aug 19;368(9536):687-93.
Kaye DK, Kakaire O, Nakimuli A, Osinde MO, Mbalinda SN. Maternal mortality and cardiovascular disease in Uganda: case series from Mulago National Referral Hospital. BMC Res Notes. 2014 Sep 16;7:693.
Bello N, Rendon ISH, Arany Z. The relationship between preeclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis. J Am Coll Cardiol. 2013 Oct 29;62(18):1715-23.
Muhumuza G, Kayondo M, Kisembo H. Case report: A 23-year-old Ugandan woman with postpartum cardiomyopathy. Afr J Med Case Rep. 2024;6(2):45-8.
Jayte, M. Adherence to lifestyle modification practices and its associated factors among hypertensive patients in Bahir Dar City hospitals, North West Ethiopia [Letter]. Integr Blood Press Control. 2024 Feb 23;17:17-8.
Bhatla N, Lal S, Behera G, Kriplani A, Mittal S, Agarwal N, et al. Cardiac disease in pregnancy. Int J Gynaecol Obstet. 2003 Aug;82(2):153-9.
Hilfiker-Kleiner D, Haghikia A, Nonhoff J, Bauersachs J. Peripartum cardiomyopathy: current management and future perspectives. Eur Heart J. 2015 ;36(18):1090-7.
McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019 Nov 21;381(21):1995-2008.
Jayte, M. Evaluating the effectiveness of a self-management program on patients living with chronic diseases [Letter]. Risk Manag Healthc Policy. 2024 Apr 23;17:1037-8.
Jayte, M. Prevalence and associated factors of psychological distress among diabetic patients at Thyolo District Hospital in Malawi: a hospital-based cross-sectional study [Letter]. Diabetes Metab Syndr Obes. 2024 Mar 5;17:1117-8.

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