Intersection of Heart Failure and Pregnancy: Beyond Peripartum Cardiomyopathy
Why the study?
Heart failure is a leading cause of maternal morbidity and mortality, but women with preexisting cardiomyopathies, systolic dysfunction, and non-peripartum HF etiologies face complex risks during pregnancy.
Structured PICO
P
Population
Pregnant women with heart failure, including peripartum cardiomyopathy, preexisting cardiomyopathies, and de novo HF
This review provides a comprehensive overview of the management, risk assessment, and implications of pregnancy in women with preexisting cardiomyopathies and de novo heart failure.
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Expert preconception counseling and appropriate risk stratification are necessary to provide individuals with the education and data needed for shared decision-making regarding the safety of pregnancy and potential outcomes.”
MMMichelle M. KittlesonProfessor of medicine, Smidt Heart Institute, Cedars-Sinai
“We know that we do not do a great job caring for pregnant individuals across the world, especially in the U.S. Maternal mortality continues to rise and that is particularly true for women with CVD, which accounts for more than one-third of pregnancy-related deaths. Women with a cardiomyopathy have a greater risk for an adverse cardiac event, including in-hospital mortality — fourfold greater if you have a cardiomyopathy event compared with other types of CVD. This is a huge problem.”
AJArthur Jason VaughtMaternal-fetal medicine subspecialist, Johns Hopkins Medicine
“Heart disease is a leading cause of maternal deaths, and it's a growing problem. This new guidance focuses attention on heart failure in pregnancy so that we can improve both short- and long-term quality of life for our patients. Getting accurately diagnosed and treated for heart disease, either before pregnancy or early in pregnancy, is both life-prolonging and life-changing if caught early.”
Implication
Requires balancing HF meds for maternal stability vs fetal safety; leaves open optimal risk tools in pregnant cardiomyopathy patients.
Abstract
Heart failure (HF) is a leading cause of morbidity and mortality in pregnant women in the United States. Although peripartum cardiomyopathy is the most common diagnosis for pregnant women with HF, women with preexisting cardiomyopathies and systolic dysfunction are also at risk as the hemodynamic demands of pregnancy can lead to decompensation, arrhythmia, and rarely death. The differential diagnosis of HF in pregnancy is broad and includes Takotsubo or stress cardiomyopathy, exacerbation of a preexisting cardiomyopathy, such as familial cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, or left ventricular noncompaction. This review will explore the implications of pregnancy in women with preexisting cardiomyopathies and de novo HF, risk assessment and preconception planning, decisions about contraception, the safety of HF medications and implantable cardioverter-defibrillators during pregnancy, pregnancy in women with left ventricular assist devices and following heart transplantation.
Coverage & sources
Journal, society, and media accounts. Useful signal, not independent expert judgment.
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Cite This Study
DeFilippis et al. (2021) studied this question.