BACKGROUND AND PURPOSE:

• Although relatively rare, the incidence of peripartum appears to be increasing
• Clinical course is variable from full recovery to up to a 30% mortality rate
• Recommendations tend toward discouraging pregnancy due to risk of recurrence
• With improving care and technology, more women are surviving and robust data on risks for future pregnancy are limited
• Codsi et al. (Obstetrics & Gynecology, 2018) examined subsequent pregnancies of women with peripartum cardiomyopathy

METHODS:

• Retrospective cohort study
• Participants: All pregnant patients with prior peripartum cardiomyopathy defined as
  • Development of cardiac failure in the last month of pregnancy or within 5 months of delivery
  • Absence of an identifiable cause of cardiac failure
  • Absence of recognizable structural heart disease before the last month of pregnancy, and
  • Left ventricular (LV) systolic dysfunction with an LV ejection fraction (LVEF) <45%
• Maternal and neonatal outcome data were abstracted
• All echocardiography examinations were individually reviewed

RESULTS:

• Data was collected for 25 patients with prior peripartum cardiomyopathy
• 60% of index pregnancies had a hypertensive disorder of pregnancy
  • Three (12%) patients with gestational hypertension, nine (36%) with preeclampsia, and three (12%) with confirmed eclampsia
• 12.1% of patients had a hypertensive disorder of pregnancy in subsequent pregnancies
• All subjects except one had recovered LV function (ejection fraction 50% or greater) before the subsequent pregnancy
• 43 subsequent pregnancies were identified with
  • 6 (14.0%) miscarriages
  • 4 (9.3%) terminations
  • 33 (76.7%) live births
• The rate of peripartum cardiomyopathy relapse was 20.9%
  • Median LVEF nadir in patients with relapse was 43% (range 35-45%)
  • None had LVEF decline to the level of their index pregnancy
  • All patients with relapse recovered LV function within a median of 1 month
• No cardiac arrests or deaths were observed
• Median gestational age at delivery for all live births in subsequent pregnancies was 39.0 weeks (range 36 6/7-41 3/7 weeks)

CONCLUSION:

• Patients with prior peripartum cardiomyopathy who recover LV function are at risk for a minor decrease in LV ejection fraction during future pregnancies
• Neonatal and maternal outcomes are very favorable
• Authors suggest the results of this study are encouraging, although further data would be required to determine optimal management in more diverse populations

Learn More – Primary Sources:

Subsequent Pregnancy Outcomes in Patients With Peripartum Cardiomyopathy 

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