Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy.

Background: Peripartum cardiomyopathy is a rare but sometimes fatal form of heart failure. Little is known about the outcomes of subsequent pregnancie s in women who have had the disorder. Methods: Through a survey of members of the American College of Cardiology, we identified 44 women who had had peripartum cardiomyopathy and had a tot al of 60 subsequent pregnancies. We then reviewed the medical records of th ese women and interviewed the women or their physicians. Results: Among the first subsequent pregnancies in the 44 women, 28 occurre d in women in whom left ventricular function had returned to normal (group 1) and 16 occurred in women with persistent left ventricular dysfunction (g roup 2). The pregnancies were associated with a reduction in the mean (+/-S D) left ventricular ejection fraction both in the total cohort (from 49+/-1 2 percent to 42+/-13 percent, P<0.001) and in each group separately (from 5 6+/-7 percent to 49+/-10 percent in group 1, P=0.002; and from 36+/-9 perce nt to 32+/-11 percent in group 2, P=0.08). During these pregnancies, sympto ms of heart failure occurred in 21 percent of the women in group 1 and 44 p ercent of those in group 2. The mortality rate was 0 percent in group 1 and 19 percent in group 2 (P=0.06). In addition, the frequency of premature de livery was higher in group 2 (37 percent vs. 11 percent), as was that of th erapeutic abortions (25 percent vs. 4 percent). Conclusions: Subsequent pregnancy in women with a history of peripartum car diomyopathy is associated with a significant decrease in left ventricular f unction and can result in clinical deterioration and even death. (N Engl J Med 2001;344:1567-71.) Copyright (C) 2001 Massachusetts Medical Society.