Psychiatric Comorbidities in Peripartum Cardiomyopathy: A Systematic Review of Prevalence, Mechanisms, and Impact on Cardiac Outcome

Peripartum cardiomyopathy (PPCM) is a pregnancy-associated cardiomyopathy and an important cause of maternal cardiovascular morbidity and mortality. Emerging evidence suggests that psychiatric comorbidities may adversely affect cardiovascular rehabilitation and quality of life in women with PPCM; however, their prevalence and clinical significance remain insufficiently understood. This systematic review aimed to evaluate the prevalence, mechanisms, and cardiovascular impact of psychiatric comorbidities in PPCM. The review was registered in PROSPERO and conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Five electronic databases (PubMed, Scopus, Web of Science, DOAJ, and Semantic Scholar) were searched up to February 28, 2026. Eligible studies included observational, cohort, case–control, qualitative studies, and clinical trials reporting psychiatric outcomes in women with PPCM. Risk of bias was assessed using National Institutes of Health and Joanna Briggs Institute tools, and findings were narratively synthesized. Of 1183 records identified, 10 studies met eligibility criteria. Depression, anxiety, and post-traumatic stress disorder were the most frequently reported psychiatric conditions, with prevalence rates ranging from 26% to 56% across studies. Psychiatric morbidity was associated with poorer treatment adherence, impaired quality of life, persistent symptoms, and delayed cardiovascular recovery. Proposed mechanisms included inflammatory activation, neurohormonal dysregulation, autonomic dysfunction, and psychosocial stressors unique to the peripartum period. Psychiatric comorbidity appears to be common and clinically significant in PPCM. Early identification and integrated multidisciplinary collaboration may improve both psychological well-being and long-term cardiovascular recovery in this vulnerable population. To our knowledge, this is the first systematic review focusing exclusively on psychiatric comorbidities in PPCM.