Impact of pregnancy on mortality in dilated cardiomyopathy. Immediate and 12- months postpartum outcomes. Data from the InCor Registry

Abstract Introduction Pregnant women with dilated cardiomyopathy (DCM) are at high risk for complications and maternal death due to hemodynamic overload during pregnancy and postpartum, interruption of essential therapies that are teratogenic, and treatment limitations for cardiac decompensation during pregnancy. Purpose To evaluate maternal and fetal outcomes in women with DCM during pregnancy and up to 12 months postpartum, considering different causes, and to identify predictors of maternal death. Methods Over a 10-year period, among 983 pregnant women from the InCor Pregnancy and Heart Disease Registry, 90 women with DCM were analysed (Table 1). Some had a history of cardiac arrest, ICD or pacemaker implants. Treatment during pregnancy included beta-blockers, hydralazine, furosemide, nitrates, enoxaparin, and hospitalization. After delivery, standard non-pregnant patient guidelines were recomended. Maternal conditions and left ventricular ejection fraction (LVEF%) were monitored during pregnancy, and up to 12 months. Maternal complications studied included heart failure, arrhythmias, thromboembolism, and death. Logistic regression analysis was used, considering p0.05 as significant. Results The percentage of maternal complications was 51.1% (46/90) during pregnancy, 36.0% (32/89) in postpartum, and 38.6% (32/83) up to 12 months postpartum. Nine maternal deaths (10%) occurred after delivery, two on the 2nd and 9th postpartum days, and seven on average 8.8 ± 3.1 months later, primarily due to advanced heart failure and one due to sudden cardiac death.The ejection fraction of deceased patients ranged from 16% to 38% (mean 24.7%). LVEF% did not differ significantly between pregnancy and 12 months postpartum (39% vs. 42%, p=0.071). Among the cases, 75% were cesarean sections, 10% involved fetal losses (6 abortions and 3 stillbirths), and the average birth weight of live-born infants was 2606g, with 33.8% being premature. Multivariate analysis showed that LVEF% (OR 0.87, p=0.006) and previous thromboembolism (OR 15.5, p=0.017) were correlated with maternal death.( Table 2) Conclusions This study showed a high rate of complications and deaths in women with DCM, regardless of the disease's etiology. An important finding was the discrepancy between the absence of deaths during pregnancy and the substantial number of deaths in the postpartum and up to 12 months later. This suggests gaps in optimizing heart failure treatment after pregnancy.This study emphasizes the urgency to improve the multidisciplinary team's skill to recognize severe heart failure during the postpartum period and the importance of safe, effective contraception for women with DCM.Table 1 Baseline characteristics Table 2 Predictors of maternal