Subsequent pregnancies risky for women with peripartum cardiomyopathy
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Key takeaways:
- Women with peripartum cardiomyopathy who recover left ventricular systolic function have unfavorable long-term outcomes with subsequent pregnancies.
- Prospective studies could guide risk stratification.
Women with peripartum cardiomyopathy are at greater risk for short- and long-term mortality with subsequent pregnancies, even if they recover left ventricular systolic function after the index pregnancy, data show.
“Literature on the long-term maternal outcome of subsequent pregnancies in women with peripartum cardiomyopathy is very limited,” Kalgi Modi, MD, of the department of cardiology at Louisiana State University Health Sciences Center – Shreveport, and colleagues wrote in the study background. “The current literature discourages subsequent pregnancies for patients with left ventricular ejection fraction less than 50%; however, the recommendation for patients who have recovered LV function remains unclear.”
Pachariyanon P, et al. J Am Coll Cardiol. 2023;doi:10.1016/j.jacc.2023.04.043.
In a retrospective chart review, Modi and colleagues analyzed data from 45 patients who had peripartum cardiomyopathy from 1982 to 2020 and then had a subsequent pregnancy. The mean age of patients was 27 years, 80% were Black and 75.6% came from a low socioeconomic background. Researchers compared clinical and echocardiographic findings between the recovery group (LVEF 50%; n = 30) and nonrecovery group (LVEF 50%; n = 15) after an index pregnancy.
The findings were published in the Journal of the American College of Cardiology.
Overall, subsequent pregnancies were associated with a decrease in mean LVEF from 45.1% to 41.2% (P = .009).
At 5 years, adverse outcomes were higher in the nonrecovery group compared with the recovery group, with rates of 53.3% vs. 20% (P = .04), driven by relapse of peripartum cardiomyopathy (53.3% vs 20%; P = .03). All-cause mortality at 5 years was 13.33% in the nonrecovery group and 3.33% in the recovery group (P = .25).
At a median follow-up of 8 years, adverse outcomes and all-cause mortality rates were similar in the nonrecovery and recovery groups, with rates of 53.3% vs. 33.3% (P = .2) and 20% vs. 20%, respectively.
“Our study highlights that subsequent pregnancies in women with peripartum cardiomyopathy can be associated with a high risk of major adverse events,” the researchers wrote. “Mortality remains high in future pregnancies. The normalization of LV function did not guarantee a favorable outcome in subsequent pregnancies, which strengthens the importance of long-term follow-up and risk stratification for future pregnancy even when the recovery of myocardial function is identified.”
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