Abstract 14375: Maternal Outcomes in Subsequent Pregnancies After Peripartum Cardiomyopathy

Abstract

Introduction: Peripartum cardiomyopathy (PPCM) is a rare cardiomyopathy associated with pregnancy and has a high maternal morbidity and mortality during both index and subsequent pregnancies. Data to help guide women with subsequent pregnancies is sparse. The purpose of this large retrospective study is to perform a comparative analysis of maternal outcomes in women with recovered left ventricular ejection fraction (LVEF) and persistent left ventricular (LV) dysfunction during subsequent pregnancies after PPCM. Methods: We identified 46 patients who had a subsequent pregnancy and an echocardiogram prior to their subsequent pregnancy in our registry of 121 patients with PPCM. Data in the registry was gathered by retrospective chart review. LVEF recovery was defined as improvement to >50%. We divided patients into a recovered group (RG) (n=16) and non-recovered group (NRG) (n=30). Results: Total maternal mortality among women with PPCM and subsequent pregnancy was 19%. Mortality in the RG was 22% compared to 25% in the NRG. Mortality among African Americans (AA) was 83% when compared to other ethnic groups (17%). Discussion: Maternal mortality related to PPCM in the US ranges from 7% to 20%. In our study, we found that the risk of maternal mortality among women who had one or more subsequent pregnancies was 19%. It is well known that women with non-recovered LV function before subsequent pregnancy carries a worse maternal outcome when compared to women who enter the subsequent pregnancy with recovered LV function. Our findings reaffirm this, as we found that mortality rate in the NRG was higher when compared to the RG. Our findings also align with previous studies in that, AA women had a higher mortality rate when compared to other ethnic groups. Conclusion: Recovery of LVEF predicts a better prognosis but is not an absolute protection from the risk of mortality and/or recurrent PPCM. Hence close monitoring of LVEF with serial echocardiograms is still indicated during a subsequent pregnancy. African ethnicity carries a worse maternal prognosis.