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Question:
I have cardiomyopathy and am now pregnant. How high is my risk?
I have Cardiomyopathy. At last check my EF was 60 (which is really good!!) Since then I have become pregnant and my Cardiologist has told me I now have a 50% chance of dying during pregnancy and am considered high risk. Will my Ejection Fraction be lowered that much due to the pregnancy, and if so, should I considered terminating it?
submitted by Kim from Buffalo, New York, on 11/16/09
Answer:
by Texas Heart Institute cardiologist, Christopher M. Frank, MD
There are limited amounts of high-quality data on women with heart disease who become pregnant. That said, the risk of maternal death during pregnancy differs depending on the particular kind of heart problem or cardiomyopathy that a woman has, but is generally not "50% mortality". For example, women who have had prior episodes of peripartum cardiomyopathy (a form of cardiomyopathy caused by pregnancy) who subsequently recover and have normal ejection fractions have approximately a 20% risk of developing recurrent heart failure and worsened ventricular function, and a very low death rate. Even women who have not recovered heart function only have approximately a 20% mortality, so although I generally advise such women not to become pregnant there are certainly women who choose to take the risk.
Management of heart disease in pregnancy, particularly when a physician is advising terminating the pregnancy, can be challenging both medically and emotionally, and I would certainly say that obtaining a second opinion from a physician experienced in managing pregnant patients with heart failure is a good idea. Any woman with heart disease is considered to have a high risk pregnancy, but in many cases women have gone on to have successful births.
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Updated November 2009
