Postpartum Cardiomyopathy

Pregnant woman in hospital gown
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On rare occasions, pregnancy can lead to a condition called postpartum cardiomyopathy, or pregnancy-associated heart failure. Postpartum cardiomyopathy is a form of dilated cardiomyopathy. (Cardiomyopathy  simply means heart muscle weakness.)

Women who develop postpartum cardiomyopathy experience the onset of heart failure either during the last month of pregnancy, or within five months after delivering a baby.

Because “postpartum” cardiomyopathy can actually occur before the baby is born, many cardiologists now refer to it as “peripartum cardiomyopathy.” (Peripartum means “around the time of childbirth.”)

Women who develop this condition usually have no prior underlying heart disease, and no other identifiable reason to develop heart disease. Their heart failure can be a temporary, self-limited condition, or can progress to severe, life-threatening heart failure.

What Causes Postpartum Cardiomyopathy?

The cause of postpartum cardiomyopathy is not known. There is evidence that inflammation of the heart muscle (also called myocarditis) may play an important role, and may be related to inflammatory proteins that sometimes can be found in the blood during pregnancy. There is also evidence that fetal cells that occasionally escape into the mother's bloodstream can cause an immune reaction, leading to myocarditis.

Furthermore, there may be a genetic predisposition to postpartum cardiomyopathy in some families. However, the bottom line is that we really don’t know the cause.

Who Gets Postpartum Cardiomyopathy?

While postpartum cardiomyopathy is thankfully a rare condition (occurring in about 1 of 4,000 deliveries in the U.S.), some women seem to be at higher risk than others.

Risk factors for postpartum cardiomyopathy include: age over 30 years, having delivered children before, pregnancy with multiple fetuses, African descent, a history of preeclampsia or postpartum hypertension, or cocaine abuse.

What Are The Symptoms of Postpartum Cardiomyopathy?

Since postpartum cardiomyopathy leads to heart failure, the symptoms are essentially the same as for most other forms of heart failure. These symptoms of heart failure most commonly include dyspneaorthopneaparoxysmal nocturnal dyspnea, and fluid retention. Read more about the symptoms of heart failure.

How is Postpartum Cardiomyopathy Treated?

With a few notable exceptions, postpartum cardiomyopathy is similarly to the treatment of any form of dilated cardiomyopathy.

The notable exceptions to "standard" heart failure treatment come into play when the heart failure occurs before the baby is delivered. Some of the "routine" treatments for heart failure should be withheld until delivery.

Specifically, ACE inhibitors such as Vasotec (enalapril), which are drugs that dilate blood vessels, should not be used during pregnancy, since these drugs can adversely affect the fetus. Instead, hydralazine can be substituted as a blood vessel dilator until delivery has occurred.

Similarly, the drugs spironolactone and Inspra (eplerenone) — the so-called aldosterone antagonists, which can be helpful in treating some patients with dilated cardiomyopathy — have not been tested during pregnancy, and should be avoided.

Very recently, preliminary evidence has been reported suggesting that women with postpartum cardiomyopathy might benefit from the drug bromocriptine — a drug used to treat a variety of disorders including Parkinson's disease  and hyperprolactinemia.

Bromocriptine is not a completely benign drug, however (among other things, it stops lactation), and larger clinical trials will be necessary before it can be generally recommended.

Overall, the prognosis of women who have postpartum cardiomyopathy appears to be somewhat better than for women who have other types of cardiomyopathy.  In some studies, as many as 60% of women with this condition have made a complete recovery. Still, the mortality rate with postpartum cardiomyopathy is as high as 10% after two years.

Long Term Considerations

It is especially important to know that women who have had postpartum cardiomyopathy — even the women who seem to have made a complete recovery — are at particularly high risk of developing the condition again with subsequent pregnancies.

And if postpartum cardiomyopathy occurs for a second time, the risk of more permanent and severe cardiac damage becomes very high.

So once a woman has had postpartum cardiomyopathy, it is important to take steps to avoid becoming pregnant again.

A Word From Verywell

Postpartum cardiomyopathy is a serious cardiac condition that produces heart failure during late term pregnancy or shortly after delivery. While treatment is available that helps the majority of affected women recover, it is still a dangerous cardiac problem that produces a substantial rate of disability and death. Women who have had this condition are at high risk of having a recurrence with subsequent pregnancies.

Sources:

Habedank D, Kühnle Y, Elgeti T, et al. Recovery From Peripartum Cardiomyopathy After Treatment With Bromocriptine. Eur J Heart Fail 2008; 10:1149.

Habli M, O'Brien T, Nowack E, et al. Peripartum Cardiomyopathy: Prognostic Factors for Long-term Maternal Outcome. Am J Obstet Gynecol 2008; 199:415.e1.

Sliwa K, Hilfiker-Kleiner D, Petrie MC, et al. Current State of Knowledge on Aetiology, Diagnosis, Management, and Therapy of Peripartum Cardiomyopathy: a Position Statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail 2010; 12:767.

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