Brief Communication: Outcomes of Subsequent Pregnancy after Peripartum Cardiomyopathy: A Case Series from Haiti

4 July 2006 | Volume 145 Issue 1 | Pages 30-34

Background: Maternal risks with pregnancies after an index diagnosis of peripartum cardiomyopathy (PPCM) are inadequately understood.

Objective: To describe the clinical outcomes of subsequent pregnancy in Haitian women with PPCM.

Design: Prospectively identified cases from a defined population base, 2000–2005.

Setting: Hôpital Albert Schweitzer, Deschapelles, Haiti.

Patients: 15 patients with PPCM and subsequent pregnancies among 99 prospectively identified patients with PPCM.

Measurements: Clinical and echocardiographic parameters.

Results: Fifteen women with PPCM had 16 subsequent pregnancies after the index pregnancies. Eight of these patients experienced worsening heart failure; of these, 1 died and 1 regained normal left ventricular systolic function. Seven patients tolerated pregnancy without worsening heart failure, and ventricular function recovered in these patients within 30 months after the subsequent pregnancy.

Limitations: The results may not apply to non-Haitian women, and power was insufficient to identify factors that might predict recovery (n = 15).

Conclusions: Half of the women with subsequent pregnancy after PPCM experienced worsening heart failure and long-term systolic dysfunction, while the other half experienced no deterioration and regained normal left ventricular systolic function.

Editors' Notes Context Peripartum cardiomyopathy occurs once in every 300 live births in Haiti. The outcome of subsequent pregnancies in this impoverished population is not known. Contribution The authors prospectively identified 99 cases and followed them clinically and with echocardiography. Fifteen patients became pregnant again; only 1 had already recovered normal ventricular function. Eight experienced worsening heart failure during the subsequent pregnancy; only 1 regained normal ventricular function. The remaining 7 regained normal ventricular function after the pregnancy. Cautions The study was too small to reliably identify predictors of worsening heart failure during a subsequent pregnancy. Implications Some women in heart failure from peripartum cardiomyopathy tolerate subsequent pregnancy, but many get worse. —The Editors

 

Author and Article Information

From Hôpital Albert Schweitzer, Deschapelles, Haiti; Oregon Health Sciences University, Portland, Oregon; and Mayo Clinic, Rochester, Minnesota.

Acknowledgments: The authors thank the patients, volunteers, and staff at Hôpital Albert Schweitzer.

Grant Support: No grants were received. Funding was provided through charitable contributions (Pierre Paulette Peripartum Cardiomyopathy Fund) that are separate from the operating budget of the Hôpital Albert Schweitzer.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Joseph G. Murphy, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; e-mail, murphy.joseph{at}mayo.edu.

Current Author Addresses: Dr. Fett: PPCM Project, Hôpital Albert Schweitzer, Deschapelles, Haiti, c/o 611 Sumner Avenue, Aberdeen, WA 98520.

Dr. Christie: Oregon Cardiovascular Teachings Ltd., 1461 Hilyard Street, Eugene, OR 97405.

Dr. Murphy: Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Author Contributions: Conception and design: J.D. Fett.

Analysis and interpretation of the data: J.D. Fett, L.G. Christie, J.G. Murphy.

Drafting of the article: J.D. Fett, J.G. Murphy.

Critical revision of the article for important intellectual content: J.D. Fett, J.G. Murphy.

Final approval of the article: J.D. Fett, L.G. Christie, J.G. Murphy.

Provision of study materials or patients: J.D. Fett, L.G. Christie.

Statistical expertise: J.D. Fett, J.G. Murphy.

Obtaining of funding: J.D. Fett, L.G. Christie, J.G. Murphy.

Administrative, technical, or logistic support: J.D. Fett, L.G. Christie, J.G. Murphy.

Collection and assembly of data: J.D. Fett, L.G. Christie.