Risk Stratification for Subsequent Pregnancy After Prior Peripartum Cardiomyopathy
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(2021) 23:2
Pregnancy and Cardiovascular Disease (N Scott, Section Editor)
Risk Stratification for Subsequent Pregnancy After Prior Peripartum Cardiomyopathy Esther Davis, MBBS, DPhil1,2 Evin Yucel, MD, MSc1,2,* Address *,1 Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA Email: [email protected] 2 Harvard Medical School, Boston, MA, USA
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Pregnancy and Cardiovascular Disease Keywords Peripartum cardiomyopathy I PPCM I Recurrence risk I Risk stratification I Subsequent pregnancy
Abstract Purpose of review Peripartum cardiomyopathy (PPCM) is a rare but serious cardiac complication of pregnancy. Patients with PPCM may not have completed their reproductive years and may desire future pregnancies. This review summarizes the epidemiology and pathophysiology of PPCM and gives an overview of the current knowledge of risk factors that can be used to assess the risk of pregnancy after PPCM. Recent findings An increasing body of work has been reported on pregnancy outcomes in women with a history of PPCM. The most dominant determinate of poor outcome in subsequent pregnancies (SSP) is left ventricular ejection fraction (LVEF), where persistently impaired LVEF pertains significant morbidity and mortality associated with future pregnancies. Major society guidelines recommend against SSP in women with PPCM who do not recover their LVEF. However, some experts discourage SSP even among women who normalized their LVEF due to reports of recurrence of heart failure. At present, limited data exists to allow risk stratification in this population; therefore, assessment for the lack of subclinical cardiac dysfunction may provide some reassurance. Summary The care of women with PPCM and reproductive health for women after PPCM can be challenging. Robust data highlights the increased risk for women with persistently depressed LVEF; however, evidence to risk stratify those with normalized cardiac function is limited. Going forward, further studies investigating factors predicting pregnancy outcome will hopefully provide data to allow more accurate understanding of risks and optimal management in this population.
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Curr Treat Options Cardio Med
(2021) 23:2
Introduction Peripartum cardiomyopathy (PPCM) is a rare, idiopathic, and usually dilated cardiomyopathy that presents with left ventricular (LV) systolic dysfunction towards the end of pregnancy or in the early postpartum period [1]. Affected women are often young, many of whom desire future pregnancies. For these women, understanding the risks of recurrence in subsequent pregnancy (SSP) is vital vital in making decisions about their future. Historically, all pregnancies after PPCM were considered high risk. More recently, contemporary data suggests that women who experience recovery of LV systolic function may have low risk of complications in SSPs,
whereas the risk of mortality
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