Cardiomyopathy, Peripartum

Basics

Description

  • 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

Etiology

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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