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Cardiomyopathy Peripartum Cardiomyopathy and Pregnancy Issues
Cardiomyopathy can happen before, during, or after pregnancy. Cardiomyopathy that develops late in pregnancy or within 5 months after you give birth is called peripartum cardiomyopathy, or pregnancy-related cardiomyopathy.
Cardiomyopathy during pregnancy is serious, but it is not common. The condition affects about 1 in 1,000 to 1 in 4,000 pregnant people in the United States.
Scientists are not sure what causes cardiomyopathy during pregnancy. Peripartum cardiomyopathy often resembles dilated cardiomyopathy. Scientists are studying changes linked with both conditions. In addition to looking at genes, they are studying the prolactin, which can cause changes in blood vessels.
If you already have cardiomyopathy, pregnancy can make it worse. However, people who have cardiomyopathy without any complications can have safe pregnancies.
Many people with peripartum cardiomyopathy recover completely, but some can have serious, long-term, or life-threatening complications. Possible complications include , an irregular heartbeat, stroke, and heart failure.
Talk to your provider about your risk and what you can do to help manage your heart health before, during, and after pregnancy.
Heart Health During Pregnancy
Pregnancy is a time to make your health a priority. The NHLBI offers information on heart health conditions that sometimes affect pregnant people, and tips to help guide discussions with your provider. When possible, try to see your provider before you become pregnant.
What raises your risk for peripartum cardiomyopathy?
If you already have cardiomyopathy, you will need to work with your healthcare provider during the pregnancy. If you don’t already have cardiomyopathy, your risk for getting diagnosed with it during pregnancy may be higher if you already experienced this condition and/or:
- Are older than 35 or very young, although cardiomyopathy can happen in pregnant people at any age
- Are Black or American Indian/Alaska Native
- Have or have had high during pregnancy (preeclampsia)
- Do not get enough nutrients through your diet or prenatal vitamins during pregnancy
- Have existing health conditions, such as infections, obesity, diabetes, and diseases
- Are pregnant with more than one baby (twins, triplets, or more) or have had many previous pregnancies
- Smoke or drink a lot of alcohol
- Take medicines that can damage your heart
Black women have a higher risk of peripartum cardiomyopathy compared with White women. In addition, Black women tend to be younger when they are diagnosed with the condition, and they are often diagnosed later than White women after giving birth. The hearts of Black women often are in a more weakened condition when they are first diagnosed. Black women also are less likely to recover fully and have a higher risk of death from peripartum cardiomyopathy.
What are the symptoms of peripartum cardiomyopathy?
If you have cardiomyopathy during or soon after pregnancy, you may have of heart failure, such as shortness of breath, extreme tiredness, and fluid buildup in your legs.
Because the symptoms of peripartum cardiomyopathy are similar to normal pregnancy symptoms, some people may not realize that they have this condition. This can delay diagnosis and treatment. It is important to talk to your provider if you have any symptoms or if your pregnancy symptoms get worse.
How is peripartum cardiomyopathy diagnosed and treated?
Your provider may screen you for cardiomyopathy if you had this condition with a previous pregnancy or if you had it before ever getting pregnant. Your provider will make sure that diagnostic tests and treatments are safe for you and your baby. An echocardiogram will likely show a reduced ejection fraction. Certain blood tests may show abnormal results.
Your provider will prescribe medicines to help your heart deliver oxygen-rich blood to all parts of the body and to the developing baby. Talk with your provider about medicines that are safe during pregnancy.
Some people develop serious complications and may need an implanted cardioverter defibrillator or a wearable cardioverter vest. Your provider may recommend a subcutaneous cardioverter device because it can be easily removed when the heart improves. These devices help keep people from dying of cardiac arrest while pregnant and for some months afterward as their hearts recover.
Studying a Possible Treatment for Peripartum Cardiomyopathy
The NHLBI is supporting the Peripartum Cardiomyopathy Network’s Randomized Evaluation of Bromocriptine In Myocardial Recovery THerapy (REBIRTH) for Peripartum Cardiomyopathy study. The network is testing a medicine called bromocriptine to see whether it can strengthen the hearts of pregnant people with peripartum cardiomyopathy. If you’re breastfeeding your baby, you may be able to participate in a group that’s not taking the study drug.
What are the possible effects of peripartum cardiomyopathy on the pregnancy?
Your healthcare team will watch you closely during and after your pregnancy. Pregnant people with this condition should have a cardiologist consultation, a provider who specializes in high-risk pregnancies (maternal-fetal specialist), and a provider who specializes in newborns with health problems (neonatologist). Talk with your healthcare team about giving birth in a medical center that specializes in high-risk pregnancies.
If your cardiomyopathy causes low levels during pregnancy, this may cause complications with your baby.
Most pregnant people with the condition can have a vaginal birth. If your condition is serious during pregnancy, you may need to deliver your baby early. Your doctor will talk with you about which type of delivery is safest for you and your baby.
Learn about risks to your heart health, how to protect it before and during pregnancy, and questions to ask your healthcare provider.
Is it safe to breastfeed your baby?
Your doctor will tell you whether it is safe for you to feed your breastmilk to your baby if you are having certain tests and treatments.
If your symptoms are serious or you have complications after delivery, your doctor may ask you not to breastfeed your baby. This is because breastfeeding can cause more stress on your body. Also, if you have serious symptoms, your provider may need to prescribe medicines that might not be safe for your baby.
What about planning for future pregnancies?
If you develop cardiomyopathy with one pregnancy, you have a risk of having this condition again with another pregnancy. This risk is higher if you still have symptoms or complications of cardiomyopathy. If you had cardiomyopathy before your first pregnancy, your condition may be more severe.
Talk to your provider about whether it is safe for you to become pregnant again. Your provider may recommend delaying another pregnancy until your heart has fully recovered from cardiomyopathy. After you give birth, talk with your provider about ways to improve your heart health to recover from peripartum cardiomyopathy and lower your risk of complications.
If you have cardiomyopathy, some types of birth control can raise your risk of a blood clot. Talk to your provider about types of birth control that are right for you.
If you become pregnant again, your provider will check your heart health with echocardiograms, electrocardiograms, and stress tests.
If you have a family history of cardiomyopathy or other serious heart problems, your provider may recommend testing for you, the baby, the other parent, or other family members.