Contemporary outcome of subsequent pregnancies in patients with previous peripartum cardiomyopathy.

Abstract

To describe the effect of subsequent pregnancies (SSP) on left ventricular (LV) function and outcomes in patients with peripartum cardiomyopathy (PPCM). Among146 women with PPCM who were prospectively followed at two medical centres in Israel (2007-2019), 75 SSPs (in 50 women) were identified: 8 miscarriages, 8 terminations, and 59 life birth. Forty-five patients with 59 full-term SSPs [mean age was 32.9±4.1years, LV ejection fraction (LVEF) 57.7±5.1%] were analysed. Data on LVEF at 1-month post-delivery were available in 46 and at 6months in 36 SSPs. There was a small decrease in the mean LVEF, mostly at third trimester (57.2±5.6 vs. 54.4.±7.3, P<0.001); and at 1-mont (57.9±5.7% vs. 55.4±6.1%, P=0.001) and at 6-month post-delivery (57.4±6.1 vs. 55.3±7.9%, P=0.03). In patients with pre-SSP LV LVEF ≥55%, a mild reduction in the mean group LVEF was seen at 1-month post-delivery (P=0.009). One patient with pre-SSP LVEF ≥55% developed severe relapse. In patients with pre-SSP LVEF <55%, a mild reduction in LVEF was obtained mostly at third trimester (51.1±5.6 vs 47.0±7.4%, P<0.001), which persisted at 6months (P=0.03). A relapse was observed in three (25%) women with LVEF <55%. There was no maternal mortality, 32 patients delivered by caesarean section, and there were no foetal complications. Our study indicates a favourable outcome and low likelihood of maternal mortality associated with SSP in women with a history of PPCM and recovered LV systolic function. SSP was associated with a slight reduction in LVEF mostly during the third trimester, which persisted up to 6months after delivery.