The management of peripartum cardiomyopathy – during pregnancy or afterward – is aimed at improving symptoms, slowing the progression of LV dysfunction and heart failure, and preventing arrhythmias and thromboembolism – both common complications.
Diuretics, nitrates, and hydralazine are often indicated and are safe in pregnancy, as is use of the beta-blocker metoprolol and either unfractionated heparin or low-molecular weight heparin for anticoagulation. (Anticoagulants are almost always indicated.) Nonpharmacologically, the focus is on reducing fluid and salt intake and on monitoring electrolyte levels and addressing any imbalances.
On the research front, animal studies and now preliminary data from a very small number of women with acute severe peripartum cardiomyopathy suggest that bromocriptine, an inhibitor of prolactin, may have a favorable effect on outcomes (Circulation 2010;121:1465-73).
Reported mortalities from the disease have ranged as high as 18%-56%, according to the Cruz review. On the other hand, many women will have a full recovery and a normalization of LV function. Dr. Elkayam concludes in his review that a normalization of LV function may occur in more than 50% of women with peripartum cardiomyopathy, mostly within 2-6 months after diagnosis.
Subsequent pregnancy is contraindicated in women who do not have a resolution of LV dysfunction, and even when LV function normalizes, there is a risk of recurrent and persistent dysfunction in a subsequent pregnancy.
Dr. Whiteman is associate professor and interim director of the division of maternal-fetal medicine at the University of South Florida, Tampa. She said she has no relevant financial disclosures.