Women with preexisting cardiomyopathy, such as dilated cardiomyopathy, who are followed closely during pregnancy often tolerate pregnancy and delivery. Many symptoms of a normal pregnancy can mimic heart failure in the antepartum period, and repeated maternal echocardiographic imaging is necessary during pregnancy. Risk factors for adverse outcomes include functional status at baseline and severity of systolic dysfunction. Beta-blockers are generally safe during pregnancy, but some reports suggest that they can cause intrauterine growth restriction. Cardiac complications such as worsening heart failure accompanied by worsening left ventricular ejection fraction (LVEF), arrhythmias, and cerebrovascular accidents occur most commonly in late pregnancy, as well as in the first 16 months postpartum. The level of brain natriuretic peptide (BNP) can be used to risk stratify women for adverse events. Pregnant women with dilated cardiomyopathy should be followed closely by a multidisciplinary team comprised of nurses, obstetricians, neonatologists, cardiologists, anesthesiologists, and cardiac surgeons. The team should ideally discuss a delivery plan prior to commencement of labor, with identification of the type of labor, anesthesia, and need for invasive hemodynamic monitoring.
KeywordsPregnancy Dilated cardiomyopathy Ejection fraction NYHA class
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