What improves chances?

[MrsEener]

What can a woman do or not do during a post PPCM pregancy that might improve her chances? I've been browsing this message board a little bit but I haven't seen a lot on this subject. So far I've read a bit about:

a good high risk OB who's had experience with post PPCM
medications
I saw one reference to bed rest
weight loss?

what about:
being extra careful to try to avoid getting sick
exercise
relaxation exercises (meditation etc)
modified bed rest
trying to avoid as much as possible activities that strain the heart
getting enough sleep
low salt diet

Is there evidence any of these or other things help?

Renee

[SusanD]

I think the BEST thing a woman can do to try to have a healthy post ppcm baby is to make absolutely sure she does not pursue a pg until her EF is > 50-55%. So far, this is one of the only evidence based guidelines we have.

I don't think bedrest is recommended unless signs and symptoms indicate otherwise. A lot of us were completely healthy, fit and of recommended weight (or even a bit under) with our pregnancies and STILL got PPCM, so while I think all of that is definitely helpful, it is not in any way a guarantee.

[mikeyandBellesmommy]

If your ef is over 55% and you go on to have another one there is absolutley NOTHING that you can do to prevent it.. you will get it or you won't..

[MrsEener]

I guess that's why I couldn't find much info about it on the internet. That seems so weird. Is it because pregnancy is such a big strain on the heart that everything else pales in comparison? Or is it just not well enough understood to know why?

[SusanD]

I guess that's why I couldn't find much info about it on the internet. That seems so weird. Is it because pregnancy is such a big strain on the heart that everything else pales in comparison? Or is it just not well enough understood to know why?


It is because the etiology of PPCM is still somewhat unkown. I believe from reading Dr.Fetts articles and other articles as well that researchers are narrowing down the possible causes, but they still don't have one thing to point to. I don't think PPCM happens because pregnancy is a big strain on the heart...our hospitals would be RAMPANT with PPCM if that were the case.

[SerenaWelsh]

Margie,

Dr. Fett's been kind enough to share his research, and point us in exactly the right direction to read other's research on the subject of "why PPCM?" And the nurses on this board - I don't want to leave them out. They've been amazing as well.

In layman's terms, it's safest to say that PPCM is caused by *something* and pregnancy seems to make you more susceptible to it, whatever it is while at the same time giving your heart more work to do. If it's a virus, then pregnancy lowers your immune system such that it allows the virus to attack your heart. If it's sensitized T-lymphocytes or sensitized dendritic cells or autoantibodies with antigen, it confuses the immune system so that the immune system could be attacking the heart tissue.
Either way, the heart is weakened, and due to the pregnancy is expected to double it's workload.

Imagine you're a juggler at the circus and it's your job to juggle 3 bowling balls all day. You need lot's of muscle and coordination for that. Now let's say you go on a binge diet of ice cream and potato chips and your big, muscular arms turn to flab. Because they're not as strong, they're also not as coordinated. You're more prone to dropping a ball every now and then. Oh, and at the same time, they now tell you it's your job to juggle 6 bowling balls - not just 3.

That's your PPCM heart during pregnancy.

Now, if you cut back to the normal 3 bowling ball routine and get your arms back in shape, you might just be able to handle the 6 bowling balls one day.

[tabs]

I guess that's why I couldn't find much info about it on the internet. That seems so weird. Is it because pregnancy is such a big strain on the heart that everything else pales in comparison? Or is it just not well enough understood to know why?

I think it also has to do with the fact the so many women were told not to have any more children after PPCM. It is relatively new that there are a number of post-PPCM children being born.

There has been a general lack of research, until recently, on PPCM in general without looking at subsets within PPCM. As PPCM becomes "mainstream" knowledge to health professionals, more women maybe identified allowing for larger studies to be done.

Twilah

[JAMESFETT]

The best precaution in terms of minimizing relapse of PPCM in a person with previously diagnosed PPCM is to be sure of recovery before any subsequent pregnancy. Since we don't know the exact cause, there is no known way to prevent a relapse. BUT there is a way to detect the relapse ealier, and thus to start treatment earlier, which would help to stop the process that is causing recurrunce. That involves appropriate monitoring during the subsequent pregnancy. To me the minimum surveillance would be:

1)each trimester (1st, 2nd, 3rd) of pregnancy and once postpartum doing a)echocardiogram, b)blood BNP, c)blood hs-CRP.
2)careful monitoring for symptoms of heart failure, with echo if significant change occurs, anywhere during pregnancy and up to 6 months after delivery.

Early treatment at a minium would include a beta-blocker (carvedilol) and diuretics.

That's it in a nutshell, and I would be glad to be available to discuss this with any physician caring for a patient with previous diagnosis of PPCM and a subsequent pregnancy.

James

[MrsEener]

Oh, and at the same time, they now tell you it's your job to juggle 6 bowling balls - not just 3.

That's your PPCM heart during pregnancy.



Yes, but if a typical pregnant woman is juggling 6 bowling balls, it seems a pregnant woman that takes extra precautions to keep the strain on her heart as low as possible would only be juggling 5 and thus improve her chances.

[SerenaWelsh]

But you have no control over how many bowling balls they tell you to juggle.

The only real precaution you can take is to not start another pregnancy until you've recovered full function. And, as Dr. Fett's research in Haiti would indicate, don't attempt a second subsequent pregnancy, even if the first one post PPCM was fine.

One of the hardest things for me (and I'm not wishing to have another child) is the total lack of control. The doctors say, "here, take this pill and let's see if it works." There's no one thing you can do to speed your recovery outside of something so simple as swallowing a pill.


But if I recall, you are recovered, correct? You are certainly in the best category for most likely having a successful post PPCM pregnancy. All the things you listed, while they may not be any help in preventing PPCM from developing again, will certainly make for a healthier pregnancy all the way around.