Multiple pregnancies are significantly associated with a higher risk of developing peripartum cardiomyopathy (PPCM), according to a meta-analysis published in BMC Cardiovascular Disorders.

The analysis included data from one prospective and ten retrospective studies, encompassing 11,523,332 participants across eight countries. Studies were identified through PubMed, Scopus, and ScienceDirect up to May 31, 2025. Eligible studies examined the association between multiple pregnancies and PPCM risk.

Using a random effects model with the Mantel-Haenszel method, the pooled odds ratio for PPCM among women with multiple pregnancies was 2.59 (95% confidence interval, 2.17–3.10; P < 0.00001). Study heterogeneity was moderate (I² = 36%, P = 0.03).

These findings demonstrate a strong and consistent association between multiple pregnancies and PPCM, suggesting increased cardiovascular vulnerability in women with multifetal gestations. Although the underlying mechanisms remain unclear, hemodynamic overload and hormonal factors may play contributory roles. Proactive screening and closer monitoring of women with multiple pregnancies may facilitate earlier detection and improve maternal cardiac outcomes.