Brief Communication: Outcomes of Subsequent Pregnancy After Peripartum Cardiomyopathy: A Case Series From Haiti

Abstract

In Haiti, the incidence of peripartum cardiomyopathy (PPCM)—a form of heart failure that develops in previously healthy women and begins in late pregnancy or the early postpartum period—is 10 times that in the United States. The 5-year mortality rate in 98 prospectively identified patients was 15%. This study examined outcomes in 15 women who had 16 subsequent pregnancies after having developed PPCM. Diagnostic criteria included the onset of heart failure within a month before delivery or within 5 months after delivery, a lack of preexisting heart disease, no other apparent cause of heart failure, and echocardiographic signs of systolic left ventricular dysfunction with an ejection fraction less than 0.45. Only HIV-negative women participated. Approximately three fourths of 99 women with PPCM took part in family planning and did not conceive again. More than half of the 25 patients who did not adopt family planning measures did become pregnant again. The interval from the index delivery to the subsequent delivery averaged 27 months, and women were followed up for 20 months on average after the subsequent pregnancy ended. All but one of the women conceived before fully recovering systolic left ventricular function. One patient died of severe heart failure 10 months after the subsequent pregnancy. Seven others did not become clinically worse and they went on to recover full ventricular function. In one case, heart failure worsened only after the second of 2 subsequent pregnancies. Apart from recovery of function itself, there were no identifiable clinical differences between women who did and those who did not recover cardiac function. Thus, approximately half the women in this study who became pregnant after PPCM in a previous pregnancy recovered cardiac function.