PREGNANCY in individuals with hypertrophic cardiomyopathy (HCM) does not increase long-term risks of adverse outcomes, including mortality, new research has shown.
Hypertrophic cardiomyopathy, a condition characterised by thickened heart muscle, poses unique challenges in pregnancy due to the potential for arrhythmias and heart failure. However, the long-term implications of pregnancy in individuals with HCM remain underexplored. This study analysed 10,936 reproductive-aged individuals (18–45 years) with HCM from the TriNetX database (2012–2022). Using propensity score matching, two cohorts (3,399 individuals each) were compared: those with a history of pregnancy and those without. Clinical outcomes were tracked over 10 years, focusing on mortality, major adverse cardiovascular events (MACE), arrhythmic events, and heart failure exacerbations.
The analysis revealed no significant difference in mortality (adjusted OR: 0.89; 95% CI: 0.7–1.14; P = 0.37) between groups. Similarly, MACE (adjusted OR: 1.02; 95% CI: 0.85–1.22; P = 0.80) and arrhythmic events (adjusted OR: 0.93; 95% CI: 0.73–1.18; P = 0.55) were comparable. In the obstructive HCM subgroup, findings were consistent, with a notably lower rate of heart failure exacerbations in the pregnancy cohort. These results align with prior studies suggesting favourable maternal outcomes in HCM, despite the historical perception of heightened pregnancy risks.
These findings are clinically significant, as they provide reassurance to patients and clinicians about the long-term safety of pregnancy in HCM. The study underscores the importance of multidisciplinary cardio-obstetrics teams in managing this population, facilitating close monitoring and tailored care. While these results are promising, further research is needed to address short-term risks and explore outcomes in individuals with more severe HCM phenotypes. Comprehensive preconception counselling and risk stratification remain essential to optimise care and enable informed decision-making for individuals with HCM considering pregnancy.
Katrina Thornber, EMJ
Reference
Abdeldayem J et al. Long-term impact of pregnancy on clinical outcomes in individuals with hypertrophic cardiomyopathy. JACC Adv. 2025;4(1):101426.
