Abstract 16293: Subsequent Pregnancies and Long-Term Cardiac Outcomes Among Patients With Prior Peripartum Cardiomyopathy in Kaiser Permanente Northern California

Abstract

Introduction: Current recommendations for subsequent pregnancies after peripartum cardiomyopathy (PPCM) have been based on previously reported ~30% recurrence rates of PPCM, but evidence has evolved along with clinical practice. Research Questions: What is the incidence of repeat pregnancy in patients with PPCM, and what are cardiac outcomes during and after subsequent pregnancies? Methods: Retrospective study of subsequent pregnancies among 110 pregnant patients identified with a confirmed diagnosis of peripartum cardiomyopathy (PPCM) between 1995-2004 in a Kaiser Permanente Norther California (KPNC) cohort. Results: Among 110 women with a diagnosis of PPCM, there were 58 subsequent pregnancies, including 23 live births in 16 women (15%), and 35 therapeutic or spontaneous abortions in 24 women (21%) over a follow-up period of up to 26 years. The live births included one birth for 11 women, two births for 3 women, and three births for 2 women. Among the 32 women with subsequent pregnancies, there was no maternal mortality or need for advanced mechanical circulatory support. There was 1 woman with relapse of PPCM in subsequent pregnancy, with left ventricular ejection fraction (LVEF) improvement at the latest follow up. There was no significant differences in LVEF at the latest available echocardiogram among those women with and without subsequent live birth pregnancies (Table 1, X 2 -value 0.901, p=0.95). Only 2 women, both with no documented subsequent pregnancy, had persistent severe LV systolic dysfunction at the end of follow-up. Conclusions: In the KPNC cohort, most patients with PPCM recovered LV function and there were no significant differences in LVEF among those women with and without subsequent live birth pregnancy.