Dr. Fett Subsequent pregnancy and hypertension

[Meg09]

Dear Dr. Fett, I was just wondering in your opinion about a subsequent pregnancy. I have had my heart function return to normal since PPCM (3 1/2 years ago) and have gone off PPCM medication but still have hypertension (however, had it before my first pregnancy) that is controlled with cozaar and atenolol, do you think my chance of reoccurance is higher than if I didn't have hypertension? Thanks Megan

[JAMESFETT]

Hi, Megan. It is difficult to answer that since we don't have much data to help us in those decisions when hypertensioni is added to PPCM. Without hypertension, we do know that women who have had PPCM and who do return to completely normal left ventricular function and off medications do seem to tolerate a subsequent pregnancy with little risk of worsening. If I were following such a patient, I would do an echo before pregnancy and in each trimester of the subsequent pregnancy as well as within 2 months postpartum. I would also do the laboratory evaluation of left ventricular function, blood B-type Natriuretic Peptide, before pregnancy and in each trimester, looking for a significant elevation. Although it is still in research mode as a helpful clinical guide, I think the blood high-sensitivity C-Reactive Protein is also helpful, watching for a rise in excess of 10 mg/L (as a clue to returning cardiomyopathy). The hypertension adds a dimension that Ob specialists and cardiologists have been dealing with for a long time, and they know how to manage that and so advise. Good luck and God bless.

James