The heart of the matter: pregnancy outcomes with a history of peripartum versus non-peripartum cardiomyopathy

To assess pregnancy-associated outcomes for women with a history of non-peripartum cardiomyopathy (nPCM) and a history of peripartum cardiomyopathy (PCM), with and without recovered ejection fraction (EF) prior to pregnancy. Patients from a Cardio-Obstetrics program at an academic medical center delivering from 2014-2021 were included in this retrospective cohort study if they had either: 1) a pre-existing diagnosis of ischemic or non-ischemic cardiomyopathy with reduced EF or 2) a diagnosis of PCM in a prior pregnancy. Two propensity matched control groups were created. First, a cohort of women without heart disease matched for age, race, and parity to assess for the association between CM and gestational age (GA). Second, a cohort of women without heart disease matched for age, race, parity, and GA at delivery to assess for other pregnancy complications. Composite measures were created for: 1) cardiac events: arrhythmia, myocardial infarction, stroke, heart failure admission, ICU admission, and cardiac death occurring < 1 year from pregnancy, 2) maternal events: hypertensive disorders of pregnancy, postpartum hemorrhage, thrombosis, and infection, 3) fetal events: fetal loss, growth restriction, NICU admission, and APGAR < 7, with pregnancy-associated adverse event rate being a sum of the scores. Each occurrence conferred a point to its composite score. A total of 45 cases (20 PCM and 25 nPCM) and 45 controls were included in both groups. Compared to the first cohort, patients with CM had a higher risk of preterm birth (PTB) (P< 0.001). Moreover, non-recovered EF pregnancies delivered earlier than those with recovered EF (256.80 vs 266.25 days, P=0.04,Figure 2), primarily due to iatrogenic PTB. The mean pregnancy-associated adverse event rate was 1.18 (SD 1.23) with non-recovered EF being the only significant predictor (P=0.02, Figure 1). There were no significant differences in the sub-scores. A history of CM was associated with PTB. Moreover, women with reduced baseline EF had more adverse events and delivered earlier regardless of their CM subtype.View Large Image Figure ViewerDownload Hi-res image Download (PPT)