Pregnancy and breastfeeding in the mother with cardiomyopathy

Cardiomyopathies are diseases of the heart muscle, characterised by structural and functional abnormalities of the myocardium that are not caused by ischemia, valvular problems or congenital heart disease. They are responsible for one-third of pregnancy-related cardiovascular deaths. A woman may enter pregnancy with a pre-existing diagnosis, or the cardiomyopathy may emerge or develop de novo during pregnancy. The most common cardiomyopathies encountered in pregnancy are dilated cardiomyopathy, hypertrophic cardiomyopathy and peripartum cardiomyopathy. All cardiomyopathies can be complicated by clinical heart failure, arrhythmia and thromboembolic events. Pregnancy may be poorly tolerated in women with dilated cardiomyopathy. New York Heart Association Class (NYHA) III/IV symptoms, and severe left ventricular dysfunction are the main determinants of adverse maternal outcomes. Peripartum cardiomyopathy is a diagnosis of exclusion with symptom onset towards the end of pregnancy, or within a few months following delivery. The management of heart failure and arrhythmias is based upon established guidelines, tailored for the unique considerations of pregnancy. Contemporary data suggests that recovery in cardiac function by 12 months is approximately 60-70% for the peripartum group. Maternal cardiovascular risk can be determined using specific risk-predictive scores. All patients with cardiomyopathy who wish to consider pregnancy should be offered individualized pre-conception and contraceptive counselling by a multidisciplinary team. This article reviews the management of women with cardiomyopathy during pregnancy and breastfeeding, focusing on the essential role of the multidisciplinary team at every stage of pregnancy and postpartum period to improve the maternal, fetal, and neonatal outcomes.