Post PPCM pregnancy time frame - Dr. Fett

[miachic]

Hi Dr. Fett. If I wanted to get pregnant in the future, what is a good amount of time to wait? I was diagnosed in April of this year so what would you say is a good time frame to wait to let my body recover? We were thinking of possibly trying (if we get to that point - still a little freaked out) around April 2007 which would be two years from diagnosis. What are your thoughts?

Emily

[JAMESFETT]

Emily, I know you do appreciate that the most important element about a subsequent pregnancy in previously diagnosed PPCM patients is not time. The most important element is full recovery of left ventricular systolic function. In some PPCM patients 2 years or even less is sufficient. In others it is not. I am trying to promote the identification of risk assessment in just such situations, to include the following:

Recent investigations of peripartum cardiomyopathy (PPCM) suggest that some tools for risk assessment may be available. The existence of such a test or tests could help to identify those with greater potential to a)survive the disease, b)eventually recover left ventricular systolic function, c)avoid future relapse of heart failure, and d)successfully experience a later pregnancy. Although not meant to be an exclusive list, I believe these five tests merit additional studies:
1)Plasma cardiac protein autoantibodies,
2)Maturation of progenitor antigen-presenting cells (dendritic cells),
3)Plasma high sensitivity-C-Reactive Protein,
4)Plasma Fas, and
5)Myocardial inotropic contractile reserve.

These are research efforts, and we will be hearing more about them as time moves along.

JD

[miachic]

Thanks Dr. Fett. I know that I would need to recover full function before I would even consider thinking about getting pregnant again. I've read all the risks involved with getting pregnant with not being fully recovered. I am currently at 54% EF and my heart size is back to normal as far as I know from preliminary results of my stress test. I will be getting another echo in January to find out further results and to see what my function and heart look like. After that test, if everything looks normal, my cardiologist said we can talk about future pregnancies. Maybe I'll ask him about these tests when I go to see him. I am saving all the information you've given me so I can share it with him.

Thanks again!

Emily

[miachic]

P.S. When would be a good time to get these tests done? Now or when I'm ready to start thinking about trying to get pregnant again? Would the results be different now as opposed to getting them done in a year or so? Also, are these covered by insurance or would it be one of those patient requested things that I would have to pay for? Do you know that answer? Oh, and would my regular cardiologist know what these tests are?

Emily

[JAMESFETT]

Of the 5 I listed, only 3 are available in a non-research setting:

1)plasma hs-CRP (any lab)
2)dobutamine challenge for contractile reserve (only certain centers do this)

JD