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Jul 14, 2011

Pregnancy in Patients with Cardiomyopathies

Individualized approach helps women with heart conditions have safe pregnancies and deliveries.

Cardiomyopathy is a weakening or changing of the heart muscle that prevents the heart from pumping blood properly to the rest of the body. Two of the most common types of cardiomyopathy include dilated and hypertrophic cardiomyopathy. Dilated cardiomyopathy is a condition in which the heart becomes enlarged, whereas hypertrophic cardiomyopathy occurs when the heart muscle becomes thick and hardened. Both conditions put strain on the heart and can cause serious complications, such as heart failure, blood clots, heart murmurs, heart attack and sudden cardiac death.

Given the many risks and complications associated with cardiomyopathy, doctors have long advised many patients with this condition to avoid pregnancy. Between pregnancy, labor and delivery, the strain put on the heart may be too much for the patient’s body to bear. However, new guidelines published in the Journal of the American College of Cardiology may help improve outcomes for pregnant women with pre-existing cardiomyopathies.

First, these guidelines help clarify the risks associated with pregnancy and cardiomyopathy. It is important that women with cardiomyopathies consult with a cardiologist before getting pregnant to assess their cardiovascular health and determine how risky pregnancy will be. If a patient has already presented symptoms of cardiomyopathy, her condition may have already progressed, and risk for a cardiac event and death may be too high. However, patients with less severe cardiomyopathies may be more equipped to make it through a pregnancy without incident.

After determining that it is relatively safe for a patient with cardiomyopathy to become pregnant, individualized approaches are key to a safe pregnancy and delivery. Patients with cardiomyopathies should check with both their obstetrician and cardiologist regularly during pregnancy, and have both present during labor and delivery. They should also deliver at a high-risk center that is best equipped to deal with various complications associated with delivery.

Overall, pregnancy in patients with cardiomyopathies does have substantial risks. However, with recent research and guidelines, patients and healthcare providers have the tools to evaluate risk and create the best possible plan for a safe pregnancy and delivery.

Read this Article in the Journal of the American College of Cardiology.

Questions for You to Consider

  • What are the most common complications associated with cardiomyopathies during pregnancy, labor and delivery?
  • Patients with cardiomyopathies are at increased risk for heart failure, arrhythmias and sudden cardiac death from pregnancy to delivery. Risk can vary greatly, however, based on the type and severity of cardiomyopathy in a patient.
  • How do pregnancy, labor and delivery put extra stress on the heart?

  • During pregnancy, heart rate increases up to 20%, and the heart needs to work 30-50% harder to pump the amount of blood needed for the body and fetus. During labor and delivery, pain, stress and blood loss puts extra stress on the heart, which can lead to heart failure and sudden cardiac death.

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