Peripartum Cadiomyopathy – A Rare but Deadly Threat to Pregnant and Postpartum Women
Dr. Samantha Crites, Mon Health Cardiologist, and Dr. Shane Prettyman, Mon Health OBGYN, weigh in on a rare, but sometimes silent and deadly threat to pregnant and postpartum women.
What is peripartum cardiomyopathy?
Peripartum cardiomyopathy (PPCM) is heart failure that occurs during pregnancy or immediately after childbirth. It is rare and varies in severity—with mild cases ending in a quick, full recovery and the most severe cases requiring a heart transplant.
According to Mon Health cardiologist Dr. Samantha Crites, the disease is rare in the United States, affecting a little over 1,000 people a year. But it’s symptoms can mimic those in third trimester pregnancy, so it’s important for expecting mothers to be aware.
“This type of heart failure develops at some point between the last month of pregnancy and up to five months after delivery,” says Crites. “The condition causes the heart to enlarge and weaken and therefore it’s unable to properly pump blood throughout the body.”
What causes peripartum cardiomyopathy?
Scientists aren’t sure what causes some women to develop heart failure during pregnancy or shortly after childbirth. But most experts agree that genetics may play a role, in addition to certain risk factors that increase a woman’s chances of having PPCM.
- Giving birth more than once
- African American race
- Pregnancy in advanced maternal age
- Twin pregnancies
- History of hypertension, preeclampsia or eclampsia
How is peripartum cardiomyopathy diagnosed?
Dr. Shane Prettyman, a Mon Health OBGYN, says PPCM can be diagnosed during a routine pregnancy or postpartum exam, or after delivery when symptoms become much more obvious and severe.
“In very mild cases, women may not notice there’s something wrong because symptoms like swollen legs and feet mimic those of pregnancy in the third trimester,” says Dr. Prettyman. “In severe cases, the disease usually reveals itself shortly after delivery when swelling and shortness of breath become severe. When this happens, we bring in a cardiologist for further, immediate testing and treatment.”
According to the American Heart Association, peripartum cardiomyopathy is diagnosed when three criteria are met:
- When heart failure occurs in the last month of pregnancy or within five months postpartum
- When tests reveal an ejection fraction (aka—how much blood is pumped out with each contraction) of less than 45 percent, with normal being between 55-70 percent
- When no other found cause can explain heart failure with reduced ejection fraction
How is peripartum cardiomyopathy treated?
Treatment differs based on severity and medical history. Some cases can be treated with medication, while others require more invasive procedures.
Treatment may include:
- Angiotensin converting enzyme (ACE inhibitors)
- Beta blockers – Slows down heartbeats to give it time to recover
- Diuretics – Reduces fluid retention
- Digitalis – Naturally derived from the foxglove plant, strengthens the ability of the heart to pump
- Anticoagulants – Thins the blood to prevent blood clots
- Heart transplant
Can I prevent peripartum cardiomyopathy?
Unfortunately, you can’t always prevent heart failure. But making small, healthy decisions in everyday life can go a long way in decreasing your chances, according to Dr. Crites.
“Since family history does seem to play a factor in peripartum cardiomyopathy, we can’t 100% prevent it,” says Dr. Crites. “But choosing a healthy lifestyle also plays a role in decreasing risks, so focusing on that is the best preventative tool we have available”
Dr. Crites adds the following ways to decrease your chances of PPCM:
- Eat a well-balanced diet (lean proteins, complex carbohydrates, fruits, veggies and fiber-rich whole grains)
- Stay active (a minimum of 30 minutes per day of activity)
- Don’t smoke or use tobacco products
- Avoid alcohol
- Manage stress
- Monitor and control your blood pressure
- Keep cholesterol and triglycerides in check
To learn more, visit our blog post for tips on staying healthy during pregnancy.