Cardiomyopathy, Peripartum

Basics

Dilated cardiomyopathy occurring during the last month of pregnancy or up to 5 mo following delivery
Diagnostic criteria (all required):
- Onset of myocardial failure during last month of pregnancy or first 5 mo after delivery
- Absence of a specific cause
- Absence of prior cardiac disease
Diagnosis requires strict criteria of echocardiographic dysfunction: LVEF <45%
Incidence: 3–5/10,000 live births
- Varies based on geographic location
Mortality: 18–56%
Risk factors:
- Older women (>30 yr)
- Multiparous women
- Multiple gestations
- Prolonged tocolytic therapy (>4 wk)
- Obesity
- Cocaine abuse
- Preeclampsia
- African American
Systemic and pulmonary embolism more frequent than with other forms of cardiomyopathy
Factors indicating a poor prognosis:
- Lower left ejection fraction at 6 mo postpartum
- Onset >2 wk postpartum
- Age >30 yr
- African American descent
- Multiparity
46–63% have LVEF recovery in 6 mo

Various causes are suggested but remain unproved:

Viral infection leading to myocarditis in presence of immunosuppression during pregnancy (most likely)
Immunologic response to an unknown maternal or fetal antigen
Abnormal prolactin processing
Abnormal angiogenesis/vascular damage
Maladaptive response to the hemodynamic stresses/LV remodeling of pregnancy
Stress-activated/inflammatory cytokines
Prolonged tocolysis
Selenium deficiency

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