Pregnancies in women after peri-partum cardiomyopathy: the global European Society of Cardiology EuroObservational Research Programme Peri-Partum Cardiomyopathy Registry
Key result
In women with prior peri-partum cardiomyopathy, clinical worsening occurred in 20% of subsequent pregnancies, and baseline LVEF <50% was not associated with increased adverse maternal outcomes.
Why the study?
There were limited contemporary, prospective data on subsequent pregnancy outcomes in peripartum cardiomyopathy patients across diverse ethnic and sociodemographic groups.
Key Points
- This study aims to assess maternal and neonatal outcomes in women with peri-partum cardiomyopathy during subsequent pregnancies.
- Sub-study of the European Society of Cardiology PPCM Registry, recruiting patients from 2012 to 2023.
- Analyzed outcomes of 98 subsequent pregnancies among 73 women with peri-partum cardiomyopathy.
- 26% of subsequent pregnancies ended prematurely; 20% experienced clinical worsening, with 2% maternal mortality.
- Median follow-up time was 198 days, with 69% of women achieving a left ventricular ejection fraction ≥50%.
- Pre-term delivery occurred in 24% of cases, and 20% of infants had low birth weight.
Study Design
Type
Cohort (n=73)
Multicenter
Yes
Structured PICO
P
Population
73 women with a history of peri-partum cardiomyopathy undergoing 98 subsequent pregnancies, followed for a median of 198 days post-pregnancy.
O
Outcome
Maternal and neonatal outcomes, including clinical worsening (composite of all-cause death, cardiovascular rehospitalization, or decline in LVEF ≥10 percentage points and to <50%)composite
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The data from our latest study suggest that a subsequent pregnancy in PPCM patients with a justifiable risk seems possible not only when heart function has recovered, but also when it is only slightly restricted.”
“It has been shown in previous studies that patients with a still greatly reduced heart function who become pregnant again have a higher risk of a deterioration in the heart's pumping function in a subsequent pregnancy. However, in our current studies have found that the risk of the mothers becoming seriously ill or even dying was lower than expected.”
Implication
Subsequent pregnancies in women with prior peri-partum cardiomyopathy had lower than anticipated maternal morbidity and mortality, suggesting that reclassification of persisting mild LV impairment from mWHO Class IV to Class III may be considered.
Abstract
BACKGROUND AND AIMS: The risk of heart failure progression or mortality in patients with peri-partum cardiomyopathy (PPCM) during subsequent pregnancies (SSPs) is a significant concern for patients, their families, and healthcare providers. However, there is limited contemporary, prospective data on SSP outcomes in PPCM patients from diverse ethnic and sociodemographic groups. This study aimed to assess maternal and neonatal outcomes in PPCM patients undergoing SSPs. METHODS: This is a sub-study on PPCM and SSPs of the global European Society of Cardiology PPCM Registry that recruited patients from 2012 to 2023. Maternal and neonatal outcomes were reported. RESULTS: From 332 patients with PPCM, there were 98 SSPs among 73 women. Of these, 25 (26%) SSPs ended prematurely due to therapeutic termination (20/25), miscarriage (4/25), and stillbirth (1/25). The median follow-up from the end of the SSP was 198 days (inter-quartile range 160-240). Left ventricular ejection fraction (LVEF) was persistently reduced to <50% prior to the SSP in 26% of patients, with only 6% having an LVEF <40%. Patient characteristics were similar, irrespective of SSP baseline LVEF. Clinical worsening [composite of all-cause death, cardiovascular rehospitalization, or decline in LVEF ≥10% (percentage points) and to <50%] occurred in 20% SSPs, with 2% all-cause maternal mortality. Signs/symptoms of heart failure and worsening of New York Heart Association class occurred in 26% and 22% of SSPs, respectively. At follow-up, the mean LVEF was 50% (±12%), and in 69% of SSPs, the LVEF was ≥50%. African women had similar outcome as the other ethnic groups. Pre-term delivery occurred in 24% of SSPs, 20% of babies were of low birth weight, and there was 3% all-cause neonatal mortality. Compared with women with SSP baseline LVEF <50%, fewer women with LVEF ≥50% were on heart failure pharmacotherapies prior to the SSP, and in this group of women, there was a significant decline in LVEF. CONCLUSIONS: Maternal morbidity and mortality rates were lower than anticipated. Baseline LVEF <50% was not associated with an increased frequency of adverse maternal outcomes, and no further decline in LVEF was observed in this group. In contrast, women with SSPs and a baseline LVEF ≥50% experienced a decline in LVEF, potentially attributable to reduced use of heart failure pharmacotherapy during pregnancy and the post-partum period. Therapeutic termination was performed in approximately a fifth of cases. The findings suggest that reclassification of a SSP with persisting mild left ventricular impairment from modified World Health Organization (mWHO) Class IV (contraindicated) to mWHO III may be considered, while remaining under the care of an experienced medical team and with appropriate pharmacological management.
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Cite This Study
Sliwa et al. (2025) conducted a cohort in Peri-partum cardiomyopathy (n=73). Subsequent pregnancy was evaluated on Clinical worsening (composite of all-cause death, cardiovascular rehospitalization, or decline in LVEF ≥10% and to <50%). In women with prior peri-partum cardiomyopathy, clinical worsening occurred in 20% of subsequent pregnancies, and baseline LVEF <50% was not associated with increased adverse maternal outcomes.