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What about future pregnancies?

Is it safe to have more children after being diagnosed with peripartum cardiomyopathy? Research studies and case studies indicate it depends on the severity of the cardiomyopathy and whether it reverses itself. If a woman develops a severe case and it does not improve after six months, she probably will be advised not to have more children. Research indicates that another pregnancy can worsen a pre-existing heart problem. In some instances, it can kill the woman. If the peripartum cardiomyopathy resolved itself within about six months, research is divided on whether it is safe to have more children. Some women have uneventful pregnancies with no redeveloping heart problem, but others develop the condition again.

A study published in 2001 (New England Journal of Medicine, Vol. 344:1567-1571) showed further heart problems in women who were considered fully recovered from peripartum cardiomyopathy and then became pregnant again. In women whose hearts were still impaired, the risks were even greater. This study reviewed the cases of 44 women who became pregnant after being diagnosed with peripartum cardiomyopathy. Of this group of 44, 28 had heart that were considered fully recovered at the time of the subsequent pregnancy (Group 1); 16 women had hearts that were still considered impaired (Group 2). Each group experienced a decline in left ventricular heart function during pregnancy. This decline in ventricular function was more than 20 percent in some cases (21 percent of group 1 and 25 percent of group 2.) Symptoms of heart failure occurred in 21 percent of group 1 and 44 percent of those in group 2. The mortality rate was 0 percent in group 1 and 19 percent in group 2 (three women died). Premature delivery occurred in 11 percent of group 1 and 37 percent of group 2. The abortion rate was 4 percent in group 1 and 25 percent in group 2. The study notes that left ventricular function declined even in those who had abortions, but by a less severe amount.

Two other studies offer further clues about the safety of another pregnancy after a diagnosis of peripartum cardiomyopathy. The first, a 1997 study from the University of Chicago Medical Center, indicates that even when women seemingly have recovered from peripartum cardiomyopathy, their hearts showed evidence of impaired contractile reserve. Seven of 10 recovered peripartum cardiomyopathy patients were given a drug (dobutamine) to simulate the cardiac stress of pregnancy. Their echocardiograms and other results were compared to a control group of healthy women. (American Journal of Obstetrics and Gynecology, 1997, Vol. 176, pp. 189-195). The second study, out of Memphis, Tenn., reviewed 28 cases of peripartum cardiomyopathy. Of this group, 6 women had subsequent pregnancies. Four out of six women redeveloped congestive heart failure, and one woman suffered deteriorating heart function but remained stable on heart medication during the pregnancy. These five patients had "clinically stable" cardiomyopathy but had not fully recovered. The one patient who did not suffer a recurrence had fully recovered from her peripartum cardiomyopathy (American Journal of Obstetrics and Gynecology, 1996, Vol. 176, p. 182-187.) However, case studies indicate a peripartum cardiomyopathy *has* occurred in some women who were thought to have completely recovered from the condition (for example, European Journal of Obstetrics and Gynecology & Reproductive Biology, 1998, Vol. 76, pp. 29-30).

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