Cardiomyopathy and Pregnancy: Considerations for Women With Severely Reduced Left Ventricular Dysfunction |
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| Affiliation: | 1. Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia;2. Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia;3. Westmead Applied Research Centre, University of Sydney, Westmead, New South Wales, Australia;4. Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland;5. Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada;6. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada;7. Population Health Research Institute, Hamilton, Ontario, Canada;8. McMaster University, Department of Medicine, Hamilton, Canada;9. Division of Maternal-Fetal Medicine, Departments of Obstetrics & Gynecology, Radiology, and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada;1. Baylor Scott & White Heart and Vascular Institute, Dallas, Texas;2. Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas;3. Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas;1. Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy;2. Università Cattolica del Sacro Cuore, Rome, Italy |
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| Abstract: | Women with dilated cardiomyopathy or left ventricular (LV) dysfunction (LV ejection fraction [LVEF] < 40%) from other etiology are at increased risk of maternal and fetal mortality and morbidity. They should undergo preconception evaluation, risk assessment, and treatment modification including discontinuation and replacement of contraindicated medications. A close follow-up and treatment by a multidisciplinary team is recommended at all stages: preconception, gestation, delivery, and postpartum. An early gestational and delivery plan has to be prepared to face complications and to achieve a successful delivery and outcome. Long-term postpartum cardiac follow-up is recommended anticipating potential adverse effects of pregnancy. The recommended mode of delivery for most patients is vaginal. The indications for cesarian section are mainly obstetric, unless the patient is in severely decompensated heart failure or urgent delivery if the patient is receiving warfarin therapy. Cardiac events during pregnancy or in the first months postpartum occur in 32%-60% of patients. Prepregnancy signs of heart failure, atrial fibrillation, and New York Heart Association functional classification (NYHA FC) > II were associated with a poor cardiac outcome. Predictors of deterioration during pregnancy that are considered very high risk and should be advised to avoid pregnancy are: patients with NYHA FC III/IV unless improved under treatment and LVEF < 20%. Predictors for high risk of adverse outcome include: LVEF < 30%, NYHA FC II, ventricular tachyarrhythmias (including patients with implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator),atrial fibrillation with rapid ventricular rate, severe mitral regurgitation, significant right ventricular failure, and hypotension. Overall, despite a high rate of complications, most women with LV dysfunction can undergo a successful pregnancy. |
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