Peripartum Cardiomyopathy: Heart Disease in Pregnancy

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Note: The Pregistry website includes expert reports on more than 2000 medications, 300 diseases, and 150 common exposures during pregnancy and lactation. For the topic Cardiomyopathy, go here. These expert reports are free of charge and can be saved and shared.

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Cardiomyopathy is a disease of the muscle of the heart. The heart becomes enlarged, thickened, or rigid, which makes it harder for the heart to pump blood and maintain its normal rhythm. As cardiomyopathy worsens, heart failure, arrhythmias, and heart valve problems may occur.

What causes it?

 Cardiomyopathy has many causes, some of which are inherited, meaning it occurs due to a change in a person’s genes that cannot be prevented, and some of which are acquired, meaning it occurs as a result of another condition or factor. Many times, the exact cause isn’t known.

A rare form of cardiomyopathy occurs at the end of pregnancy or within the first few months after birth: in peripartum cardiomyopathy (PPCM), also called postpartum cardiomyopathy, the chambers of the heart enlarge and the heart muscle weakens. As a result, less blood is pumped from the heart with each contraction and the body’s organs no longer receive the blood they need.

Only about 1000 women are diagnosed with PPCM each year. While the cause of PPCM is often not exactly known, diet, lifestyle, and other medical conditions, as well as genetics, may play a role in its development. Specific risk factors that are thought to be associated with PPCM include:

  • Obesity
  • A history of other heart disorders
  • Certain medications
  • Smoking
  • Alcoholism
  • Multiple pregnancies
  • African-American descent

How do I know if I have it?

The symptoms of PPCM are similar to symptoms experienced at the end of pregnancy, making detection and diagnosis difficult. Swelling in the feet and legs and shortness of breath are common, and other symptoms include:

  • Fatigue
  • Feeling of heart racing
  • Increased urination at nighttime
  • Swelling of neck veins
  • Low blood pressure or blood pressure that drops when you stand up

The symptoms of PPCM may be barely noticeable or they may occur even while you are at rest.

For a definitive diagnosis of PPCM, the heart failure must have occurred during the last month of pregnancy or the first 5 months after delivery; an echocardiogram shows that the heart is pumping less than 45% of the blood out of the left ventricle with each contraction (this is called the “ejection fraction”; a normal ejection fraction is between 55% and 70%); and no other cause for heart failure can be identified.

How is it treated?

The severity and frequency of symptoms helps determine the best treatment for PPCM. The goal of treatment is to help the heart function as normally as possible. Several classes of medications can be used to treat PPCM and the choice among them is made on the basis of your stage of pregnancy and whether or not you are breastfeeding.

In addition to medications, PPCM treatment usually requires a low-salt diet and fluid restriction. Women with PPCM should stop smoking and stop drinking alcohol, since these may make the condition worse.

Since the exact cause of PPCM is not known, it is difficult to prevent. However, maintaining good heart health before, during, and after pregnancy will decrease your risk of developing PPCM and other cardiovascular diseases. Eat a well-balanced diet and engage in regular exercise to keep your heart strong and healthy.

If you have a history of heart disease or any of the other risk factors for PPCM, tell your doctor so he or she can monitor your heart and lungs carefully throughout pregnancy. If you are experiencing symptoms consistent with PPCM, see you doctor. Most women with PPCM will recover within about 6 months of diagnosis, but PPCM that goes untreated puts you at risk for complications and other heart diseases in the future.

Jennifer Gibson
Dr. Jennifer Gibson earned a Bachelor of Science degree in Biochemistry from Clemson University and a Doctor of Pharmacy degree from the Medical College of Virginia School of Pharmacy at Virginia Commonwealth University. She trained as a hospital pharmacist and is the author of clinical textbooks, peer-reviewed journal articles, and continuing education programs for the medical community, as well as a contributor to award-winning healthcare blogs and websites. In her free time, she enjoys running, reading, traveling, and spending time with her family.

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