Natural course of subsequent pregnancy after peripartum cardiomyopathy

Abstract

OBJECTIVE: To assess the effect of subsequent pregnancy after peripartum cardiomyopathy (PPCM) on maternal and fetal outcome. METHODS: Prospective study of 34 patients with the diagnosis of PPCM (mean age= 26years). At the time of first diagnosis 5 were in NYHA functional class (FC) II for heart failure, one in FC III and 28 in FC IV. After clinical treatment, patients were advised to avoid new pregnancies and a follow-up was obtained. RESULTS: There were 12 (35.3%) subsequent pregnancies in patients (pt) aged 19 to 44 years (mean 32), divided into two groups: GI: 6 pts who had normalized their heart size and GII: 6 pts with persistent cardiomegaly. GI had initially mild clinical manifestations ( 3 were in FC II, 1 in FC II and 2 in FC IV) and complete recovery of cardiac function (FC I). A new pregnancy was well-tolerated in 5 (83.3%); 1 pt presented with preeclampsia, and progressed to FC II. Presently, 5 pt are in FC I and 1 in FC II. GII pts had more severe heart failure at the onset of PPCM (1 pt in FC II and 5 in FC IV); during follow-up, 4 pt were in FC I and 2 in FC II. A new pregnancy was well tolerated in all of them, but the eldest, who had had 2 pregnancies and had a progressive worsening of clinical status, dying 8 years after the last pregnancy and 13 years after the diagnosis of PPCM. The remaining 5 pt are still alive, 3 in FC I and 2 in FC II, with worsening of FC in 1. Subsequent pregnancies occurred 3-7 years after clinical treatment of PPCM and no fetal distress was observed. CONCLUSION: Subsequent pregnancies are well-tolerated after PPCM, but not devoid of risk. No fetal distress was observed. A minimum interval of 3 years after the recovery of function seems to be safe for subsequent pregnancies

Long‐term prognosis, subsequent pregnancy, contraception and overall management of peripartum cardiomyopathy: practical guidance paper from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy

“…Data on SSPs in women with a previously diagnosed PPCM are limited. Table summarizes the studies of women who had a SSP after being diagnosed with PPCM . However, the mode of data collection is highly variable with some studies not reporting the LVEF of the index pregnancy, nor the cardiac dimensions, left and right ventricular function at onset of the SSP.…”

Outcomes of subsequent pregnancy in women with peripartum cardiomyopathy: a systematic review and meta-analysis

“…All patients who died during or after the SSP entered the SSP with persistent LV dysfunction or persistent cardiomyopathy, according to seven studies. 14 16 17 21 22 24 25 However, a prospective cohort from Brazil reported there were no statistically significant differences between surviving and deceased women in terms of socioeconomic status, LV and right ventricular (RV) function before entering SSP. At the time of hospitalisation, congestive HF and lower LV and RV function were more frequently observed in women who died after pregnancy than in the group of surviving patients.…”

“… 10 14 16 18 20 21 A prospective cohort from Brazil reported increased heart size in 7 out of 12 patients in which 1 of them also developed pre-eclampsia. 14 Pre-eclampsia emerged as the predominant hypertensive complication in most studies, accounting for 50% of the total hypertension cases seen. 10 14 16 20 Codsi et al 16 and Goland et al 10 both found three cases of gestational diabetes mellitus as one of the aggravating factors of the pregnancy.…”