A NEW global study by the European Society of Cardiology (ESC) has provided fresh insights into the risks associated with subsequent pregnancies (SSPs) in women with peri-partum cardiomyopathy (PPCM). The research challenges previous assumptions about the dangers of pregnancy for women who have experienced PPCM, a rare but serious form of heart failure that occurs during or shortly after childbirth.
The study analysed data from 332 PPCM patients across diverse ethnic and socioeconomic backgrounds, with 98 SSPs recorded among 73 women. While concerns over heart failure progression and mortality have long shaped clinical guidelines, findings from this research indicate that maternal morbidity and mortality rates were lower than anticipated.
Key results showed that 20% of SSP cases experienced clinical worsening, including cardiovascular hospitalizations and a decline in left ventricular function. However, all-cause maternal mortality was relatively low at 2%. Importantly, baseline heart function did not predict worse outcomes, patients with a left ventricular ejection fraction (LVEF) below 50% at the start of pregnancy did not experience significantly higher rates of complications compared to those with normal heart function. However, those with LVEF ≥50% at baseline did show a decline in heart function, which may be linked to reduced use of heart failure medications during pregnancy.
Neonatal outcomes were also notable: preterm births occurred in 24% of cases, 20% of infants were born with low birth weight, and neonatal mortality was 3%. In about 20% of cases, pregnancy was terminated due to medical concerns.
These findings suggest that current risk classifications for PPCM patients considering pregnancy may need revision. The study proposes that a SSP in women with mild left ventricular impairment should be considered under modified World Health Organization (mWHO) Class III rather than the previously recommended Class IV (contraindicated). However, the researchers stress that such pregnancies should still be carefully managed by experienced medical teams with appropriate pharmacotherapy.
Aleksandra Zurowska, EMJ
Reference
Sliwa K et al. Pregnancies in women after peri-partum cardiomyopathy: the global European Society of Cardiology EuroObservational Research Programme Peri-Partum Cardiomyopathy Registry. Eur Heart J. 2025;DOI: 10.1093/eurheartj/ehaf006.
