Managing pregnancy in women with pre-existing cardiomyopathies: A case series

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Pre-existing cardiomyopathy in pregnancy (n=4). Intervention: Pregnancy with pre-existing cardiomyopathy.

Q: What does this research mean for the field?

Pregnancy in women with pre-existing dilated, hypertrophic, and arrhythmogenic cardiomyopathies presents varying clinical courses with distinct risks including arrhythmia, left ventricular outflow tract obstruction, and heart failure. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Charo Bruce; Claudia Montanaro; Gurleen Wander; Raghav Aggarwal; Alya Khashaba; Mark R. Johnson; Brian P. Halliday; Michael A. Gatzoulis; Isma Rafiq

doi:10.1016/j.crwh.2026.e00847

August 10, 2026Case Reports in Women s HealthOpen Access

Managing pregnancy in women with pre-existing cardiomyopathies: A case series

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Key result

Multidisciplinary care supports successful pregnancy outcomes in women with pre-existing cardiomyopathies despite maternal complications.

n=4

Figures

Graphical abstract published by Case Reports in Women s Health — Graphical abstract · Published by Case Reports in Women s Health · CC BY-NC

Why the study?

Women with pre-existing cardiomyopathy face high maternal and fetal complication rates during pregnancy, where different cardiomyopathy phenotypes and genetics influence clinical presentation, risk profiles, and management.

Key Points

To evaluate the clinical course, maternal and fetal complications, and individualized management strategies across different pre-existing cardiomyopathy phenotypes during pregnancy.
Evaluated clinical presentations, genetics, therapeutic adjustments, and peripartum outcomes in a case series of 4 pregnant women managed at a joint cardiac obstetric medicine clinic.
Tracked maternal cardiovascular status, serial biomarkers, and fetal wellbeing across phenotypes comprising dilated cardiomyopathy (DCM), arrhythmogenic cardiomyopathy (ACM), and hypertrophic cardiomyopathy (HCM).
Maternal complications varied by phenotype: DCM cases experienced atrial flutter, peripheral edema, and postpartum LVEF reduction to 34%; ACM presented with myocardial inflammation; HCM involved worsening left ventricular outflow tract obstruction and NSVT requiring antepartum S-ICD implantation.
All 4 pregnancies resulted in live births, delivered via induction of labour at 39 weeks, elective caesarean section (CS) at 37 weeks, emergency CS after failed induction, and preterm CS secondary to fetal growth restriction and maternal cardiovascular risks.

Study Design

Type

Case Report (n=4)

Structured PICO

P

Population

4 pregnant women aged 25 to 37 with pre-existing dilated, arrhythmogenic, or hypertrophic cardiomyopathy managed through pregnancy and postpartum.

E

Exposure

Individualized multidisciplinary team management, including pre-conception counseling, cessation of teratogenic prognostic medications (e.g., ACEi/ARB, ARNI, SGLT2i, spironolactone), biomarker monitoring, and tailored pharmacological or device therapy (e.g., S-ICD) during pregnancy.

O

Outcome

Maternal and fetal outcomes, including cardiac complications (arrhythmia, heart failure, LVOT obstruction) and obstetric complications.

Limitations

Small sample size
Heterogeneous cardiomyopathy phenotypes
Observational case series design

Implication

Individualized multidisciplinary care, including careful medication adjustment and monitoring, supports successful maternal and fetal outcomes in women with pre-existing cardiomyopathies during pregnancy.

Abstract

Women with pre-existing cardiomyopathy experience high maternal and fetal complication rates when undergoing pregnancy. Different cardiomyopathy phenotypes and genetics can influence the presentation during pregnancy and help inform risk profile and management. This case series demonstrates the differing course of pregnancy in dilated, hypertrophic and arrhythmogenic cardiomyopathy. The main complications managed were arrhythmia, rising left ventricular outflow tract obstruction and heart failure. The cases highlight important pre-conception considerations, the use of biomarkers, and pharmacological and device management during pregnancy, delivery and post-partum. It is important to recognise that cardiomyopathies represent a heterogeneous group of conditions with differing phenotypes which need individualised specialist care during pregnancy. Risk stratification and management by an expert multidisciplinary team are recommended to support these women to attain good maternal and fetal outcomes.

Discussion

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Cite This Study

Bruce et al. (2026) conducted a case report in Pre-existing cardiomyopathy in pregnancy (n=4). Pregnancy with pre-existing cardiomyopathy was evaluated. In four women with pre-existing cardiomyopathies, individualized multidisciplinary care during pregnancy supported successful deliveries and good fetal outcomes despite maternal complications like arrhythmias and heart failure.

synapsesocial.com/papers/6a8abc170f137e402b33a8bf https://doi.org/10.1016/j.crwh.2026.e00847

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Managing pregnancy in women with pre-existing cardiomyopathies: A case series

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Managing pregnancy in women with pre-existing cardiomyopathies: A case series

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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