Risk Factors and Risk Score (NOAM score) for Peripartum Cardiomyopathy

IntroductionPeripartum cardiomyopathy (PPCM) is a life-threatening pregnancy-associated cardiomyopathy characterized by left ventricular systolic dysfunction. Due to its relative rarity, risk factors are not well established, and a validated risk score is lacking. MethodsWe conducted a retrospective cohort study, analyzing 317,892 deliveries between January 2014-December 2024. PPCM cases were identified by individual clinical chart review and echocardiographic validation. Multivariate logistic regression identified independent predictors. A post hoc stratified analysis created five risk categories to estimate PPCM incidence. ResultsWe identified 107 PPCM cases (1:2,970 deliveries). Significant risk factors included cardiovascular disease or arrhythmias, odds ratio (OR) 8.18 (95% confidence interval [CI], 4.34 to 14.2); preeclampsia, OR 7.50 (95% CI, 4.69 to 11.7); Women of African ancestry, OR 4.39 (95% CI, 2.32 to 7.64); first delivery, OR 3.38 (95% CI, 2.25 to 5.08); multifetal pregnancy, OR 2.76 (95% CI, 1.36 to 5.07); and maternal age older than 35 years, OR 2.30 (95% CI, 1.50 to 3.48). In the post hoc stratified analysis, risk groups demonstrated marked heterogeneity, with risk ranging from 1 per 25,000-7,692 deliveries in the lowest risk group to 1 per 163-65 deliveries in the highest risk group. ConclusionWe identified risk factors for PPCM and developed the NOAM Score, a simple and clinically applicable tool that integrates several domains--preeclampsia, cardiovascular disease, hypertension, Women of African ancestry, primiparity, advanced maternal age and multifetal pregnancy. This framework stratifies women across a wide spectrum of risk and may support earlier identification, risk-guided monitoring, and targeted preventative care.