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Counseling Women With Peripartum Cardiomyopathy About Subsequent Pregnancies

  • Reproductive Health and Cardiovascular Disease (G Sharma, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

Peripartum cardiomyopathy (PPCM) is a potentially catastrophic form of heart failure caused by left ventricular systolic dysfunction that develops during pregnancy or in the early postpartum period. After the initial diagnosis and treatment, many women desire another pregnancy; however, risks of a subsequent pregnancy need to be considered, as PPCM may lead to significant adverse outcomes for both mother and fetus. The goal of this review is to provide information about risk stratification prior to subsequent pregnancy, strategies to mitigate the risk of subsequent pregnancy, and long-term maternal outcomes.

Recent findings

The degree of myocardial recovery is currently the most effective predictor of heart failure relapse and adverse outcomes during a subsequent pregnancy. Women with persistent left ventricular systolic dysfunction have worse maternal and fetal outcomes during subsequent pregnancy. Pharmacologic options for the acute management of heart failure during pregnancy are limited to diuretics, beta-blockers, hydralazine, isosorbide dinitrate, and digoxin. After delivery, however, most guideline-directed heart failure medications can be used safely, including in women who are breastfeeding. Because of the risks of subsequent pregnancy, options for contraception should be discussed with women with PPCM. Finally, women with PPCM should be under the care of a multidisciplinary cardio-obstetrics team for preconception counseling and management during a subsequent pregnancy.

Summary

An essential component of caring for women with PPCM includes detailed counseling about the risks of a subsequent pregnancy.

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Abbreviations

PPCM:

Peripartum cardiomyopathy

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

IPAC:

Investigations of Pregnancy-Associated Cardiomyopathy

NYHA:

New York Heart Association

MRI:

Magnetic resonance imaging

ESC:

European Society of Cardiology

LGE:

Late gadolinium enhancement

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA

    Megan S. Joseph MD & Melinda B. Davis MD

  2. Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA

    Melinda B. Davis MD

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Correspondence to Melinda B. Davis MD.

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Joseph, M.S., Davis, M.B. Counseling Women With Peripartum Cardiomyopathy About Subsequent Pregnancies. Curr Treat Options Cardio Med 23, 41 (2021). https://doi.org/10.1007/s11936-021-00915-4

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