Poor Long Term Outcome With Subsequent Pregnancies After Peripartum Cardiomyopathy

Poor Long Term Outcome With Subsequent Pregnancies After Peripartum Cardiomyopathy

Subsequent pregnancies are discouraged in patients who have reduced left ventricular ejection fraction after an episode of peripartum cardiomyopathy as per recommendations, though it may sometimes be considered in those who have fully recovered. A retrospective review from the US checked 137 patients with peripartum cardiomyopathy in a registry [1].

Of these 45 patients with subsequent pregnancies, with a mean age of 27 years were included in a study. 80% of the women were of African American descent and 75.6% were from low socioeconomic background. Two third of them had recovered from the initial episode as defined by a left ventricular ejection fraction 50% or more. 40% of patients had two or more subsequent pregnancies. Three or more subsequent pregnancies were noted in 6.7% of those who had not recovered and 26.7% of those who had recovered.

Subsequenct pregnancy was associated with mean decrease in LVEF from 45.1% to 41% (P = 0.009). Adverse outcomes at 5 years were significantly higher in those who had not recovered compared to those who had recovered LVEF, 53.3% vs 20%, driven by a relapse of peripartum cardiomyopathy. Five year all cause mortality was 13.33% in those who had not recovered LVEF while it was 3.3% in those who had recovered. At a median follow up of 8 years, adverse outcomes and all cause mortality were similar in both groups –  53.3% vs 33.3% (P = 0.20) and 20% vs 20%. Authors concluded that subsequent pregnancies in women with peripartum cardiomyopathy were associated with adverse events. Normalization of LVEF does not guarantee a favourable outcome in subsequent pregnancies.

An accompanying editorial highlighted the 20% mortality in both those who have recovered and in those who have not recovered initially, at 8 years [2]. An important limitation regarding generalization of the results was also pointed out. This study was from a single centre where mortality in women with peripartum cardiomyopathy was higher than in other studies from the United Studies. Most of the patients were African American and of low socioeconomic status. Earlier studies have clearly demonstrated a different phenotypic presentation and outcome in African American women with peripartum cardiomyopathy compared to non-African American women. African American women had been shown to be diagnosed later, present lower LVEF, larger LV volume and more severe heart failure symptoms. The rate of recovery was lower and time for recovery markedly longer in that patient group.

References

1. Pachariyanon P, Bogabathina H, Jaisingh K, et al. Long-Term Outcomes of Women With Peripartum Cardiomyopathy Having Subsequent Pregnancies. J Am Coll Cardiol. 2023 Jul, 82 (1) 16–26.
   https://doi.org/10.1016/j.jacc.2023.04.043
2. Elkayam U, et al. Safety of Subsequent Pregnancy After Recovery From Peripartum Cardiomyopathy. J Am Coll Cardiol. 2023 Jul, 82 (1) 27–29. https://doi.org/10.1016/j.jacc.2023.04.042