Outcome of subsequent pregnancies in patients with a history of peripartum cardiomyopathy

Eur J Heart Fail. 2017 Dec;19(12):1723-1728. doi: 10.1002/ejhf.808. Epub 2017 Mar 27.


Aims: Subsequent pregnancies (SSPs) in patients with peripartum cardiomyopathy (PPCM) have a high risk of heart failure relapse. We report on outcome of SSPs in PPCM patients in Germany, Scotland, and South Africa.

Methods and results: Among 34 PPCM patients with a SSP, pregnancy ended prematurely in four patients while it was full-term in 30. Overall relapse rate [left ventricular ejection fraction, (LVEF) <50% or death after at least 6-month follow-up] was 56% with 12% (4/34) mortality. Relapse of PPCM after SSP was not associated with differences in parity, twin pregnancy, gestational hypertension, or smoking. Persistently reduced LVEF (<50%) before entering SSP was present in 47% of patients while full recovery (LVEF ≥50%) was present in 53%. The majority of patients entering SSP with persistently reduced LVEF were of African ethnicity (75%). Persistently reduced LVEF before SSP was associated with higher mortality (25% vs. 0%) and lower rate of full recovery at follow-up. Patients obtaining standard therapy for heart failure and bromocriptine immediately after delivery displayed significantly better LVEF at follow-up and a higher rate of full recovery with no patient dying compared with patients obtaining standard therapy for heart failure alone. This was independent of African or Caucasian race.

Conclusion: Full recovery of LVEF before SSP was associated with lower mortality and better cardiac function at follow-up. Addition of bromocriptine to standard therapy for heart failure immediately after delivery was safe and seemed to be associated with a better outcome of SSP in African and Caucasian patients.

Keywords: Biomarker; Peripartum cardiomyopathy; Subsequent pregnancy; Therapy.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cardiomyopathies / diagnosis
  • Cardiomyopathies / epidemiology*
  • Cardiomyopathies / physiopathology
  • Female
  • Germany / epidemiology
  • Humans
  • Incidence
  • Infant, Newborn
  • Male
  • Peripartum Period
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / diagnosis
  • Pregnancy Complications, Cardiovascular / epidemiology*
  • Pregnancy Complications, Cardiovascular / physiopathology
  • Pregnancy Outcome
  • Scotland / epidemiology
  • South Africa / epidemiology
  • Stroke Volume / physiology*
  • Survival Rate / trends
  • Ventricular Function, Left / physiology*