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PPCM: Where We Are and What Needs to Change

When we talk about maternal health in Canada, the conversation often centres around access to midwifery care, reducing C-section rates, or improving mental health supports. But far too rarely do we talk about heart disease, which is the leading cause of maternal morbidity and mortality in developed countries, including Canada.


And among maternal heart conditions, Peripartum Cardiomyopathy (PPCM) stands out for how easily it's missed and how devastating it can be when undiagnosed.

PPCM in Canada is Still Flying Under the Radar

PPCM is a form of heart failure that occurs during the last month of pregnancy or within five months postpartum. It can affect any woman, regardless of prior cardiac history. But in Canada, PPCM still lacks a consistent national protocol for diagnosis, screening, and postpartum follow-up.


Illustration of three pregnant women.
Illustration of three pregnant women.

A 2024 provincial multicentre study based in Québec found that many cases are still being diagnosed late, after hospital readmissions for severe symptoms such as shortness of breath and chest pain. In rural and Indigenous communities, the delays can be even more pronounced due to healthcare access barriers.


The Gaps Are Wide… and Dangerous

Despite advances in cardio-obstetrics, Canada does not yet have a coordinated federal strategy for maternal heart health. According to the Canadian Cardiovascular Society, the growing number of pregnant women with pre-existing cardiac conditions (or those at high risk due to hypertension, obesity, or gestational diabetes) demands a multidisciplinary approach.


But implementation varies widely. A handful of health care providers in Ontario and British Columbia, have specialized cardio-obstetric programs, while others rely on general practitioners and emergency departments to catch red flags… often too late.


Who Is Most at Risk?

Recent research, which looked at data from over 200 million people, found that some women are more likely to develop PPCM than others. The biggest risk factors include:


  • Pre-eclampsia (a dangerous pregnancy complication with high blood pressure)

  • High blood pressure during pregnancy (also called gestational hypertension)

  • Obesity

  • Diabetes

  • Having had multiple pregnancies


These factors don’t guarantee someone will develop PPCM, but they increase the chances. That’s why early screening and heart monitoring are especially important for anyone with one or more of these risk factors. Download a free symptom track and other resources here.


These are all factors disproportionately affecting Black, Indigenous, and low-income mothers in Canada. A Winnipeg-based study also found that Indigenous women were more likely to present with severely reduced heart function and needed more intensive treatment at discharge.

 

What can we do differently?

For one, routine BNP testing in emergency departments and maternal wards could make a life-saving difference. According to the Canadian Cardiovascular Society, a BNP level over 400 pg/mL strongly suggests heart failure, but few postpartum patients receive this test unless they advocate for it themselves.


But there is hope…

Recently, Dr. Rohan D’Souza, Canada Research Chair in Maternal Health and Associate Professor at McMaster University, announced the launch of CaNCaM-Preg: the Canadian Network of Networks to Reduce Cardiovascular Mortality and Morbidity in Pregnancy. Funded by Heart & Stroke, Brain Canada, and the Canadian Institutes of Health Research – Institute of Gender and Health, this initiative has secured $5 million over five years to address the full spectrum of cardiovascular risks linked to pregnancy.


“Cardiovascular conditions remain a leading cause of severe health complications, including death, during pregnancy,” said Dr. D’Souza. “This initiative brings together expertise and lived experience to improve care and outcomes for individuals during pregnancy and beyond.”


The CaNCaM-Preg project brings together a national team of clinicians, researchers, social scientists, economists, and survivors to:


  • Review serious cardiovascular events to inform better care

  • Improve postpartum follow-up for heart conditions

  • Ensure access to specialist care during high-risk pregnancies


 

What You Can Do

Whether you're a care provider, survivor, doula, or policy advocate, here are three actions you can take right now:


  1. Ask about BNP or NT-proBNP testing if you or someone you love has symptoms like extreme fatigue, chest pain, or shortness of breath after birth.

  2. Share survivor-led PPCM resources, like our upcoming awareness toolkit or healing journal.

  3. Support equitable maternal care, especially in rural and under-served regions.

 

Sources:



We’re in this together. If this post resonated with you... whether you're a survivor, partner, birthworker, or advocate, we’d love to continue the conversation with you. Join us on social:


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📲 Use the hashtag #PPCMPulse to connect or tag us in your story... we’d love to amplify your voice.

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