Abstract 3806: Pregnancy Outcomes in Women With Dilated Cardiomyopathy
Background Pregnant women with dilated cardiomyopathy (DCM) are at risk for complications, but no studies to date have examined this specific population. The primary objective was to:
determine adverse outcomes during pregnancy in women with DCM and
compare their cardiac outcomes to nonpregnant women with DCM.
Methods This was a sub-study of a larger prospective cohort study of outcomes in women with heart disease. Maternal cardiac, obstetric and fetal outcomes in pregnancy (to 6 months postpartum) in women with DCM were examined. For comparison, cardiac outcomes in non pregnant women with DCM (controls, n=17) matched by age and left ventricular (LV) systolic function were examined over a similar time period.
Results Thirty-six pregnancies in 32 women with DCM were included. Thirty nine percent(14/36) of the pregnancies were complicated by at least one maternal cardiac event. In the multivariate analysis, moderate/severe LV dysfunction and/or NYHA Class III/IV (p=0.004) was the main determinant of adverse maternal outcomes in pregnancy. In the absence of a history of cardiovascular events, moderate/severe LV dysfunction and/or NYHA Class III/IV there were no adverse cardiac events during follow-up. In the subset of women with moderate/severe LV dysfunction, 16-month cardiac event free survival was worst in pregnant women compared to controls [HR 4.8, 95% CI (1.5–15.1), p=0.003]. The adverse neonatal event rate was highest among women with both obstetric and cardiac risk factors.
Conclusions In pregnant women with DCM the risk of adverse cardiac events is considerable and prepregnancy characteristics can identify women at the highest risk. Pregnancy appears to have a short term negative impact on the clinical course in women with DCM.