Pregnancy takes a toll on your body even when it's free of complications. But it’s critical for new moms to keep an eye out for signs of postpartum complications because in rare cases, a serious form of heart disease known as peripartum cardiomyopathy (PPCM) can develop after you’ve given birth.
Here are the PPCM red flags pregnant women and their families should know about, plus when to seek help.
Peripartum cardiomyopathy (PPCM) is a rare but serious form of heart disease that can appear sometime in the first five to six months after you've given birth or during the last month of pregnancy. The condition occurs when the heart's chambers enlarge and its muscles weaken. Symptoms of PPCM can include fatigue, heart palpitations, chest pain, shortness of breath, swelling, or low blood pressure. Many of these symptoms mimic the signs of more benign conditions, so it can be easy to brush them off, but it's absolutely critical to talk to your doctor if you're experiencing any. There’s no way to prevent PPCM entirely, but you can lower your risk by taking good care of your heart. If you’ve had PPCM in one pregnancy, you’re at higher risk of developing it again, so it's especially important that you work closely with your doctor to determine if it’s safe for you to conceive again and whether you’ll need to take certain medications while you're expecting.
What is peripartum cardiomyopathy or PPCM?
Peripartum cardiomyopathy (PPCM) — also known as postpartum or pregnancy-associated cardiomyopathy — is a rare form of heart failure that shows up the first five to six months after delivery or, less commonly, during the last month of pregnancy.[1]
This condition occurs when the heart's chambers enlarge and its muscles weaken, preventing this vital organ from pumping enough oxygen-rich blood to the rest of the body. It can sap a new mom's or mom-to-be's strength and make breathing difficult.[2]
PPCM affects about 1,000 to 1,300 American women each year.[3] According to American College of Obstetricians and Gynecologists (ACOG), it's among the leading causes of maternal deaths in the U.S., and women of color and low-income women are particularly at risk.[4] That's why it's so important to know the signs and seek the proper diagnosis and treatment if symptoms occur.
Peripartum cardiomyopathy symptoms
Symptoms of peripartum cardiomyopathy can vary depending on the severity of the condition, but the most typical signs are:
- Fatigue. While many women experience late-pregnancy or new-mom fatigue, feeling more tired than usual is one sign to watch out for.
- Heart palpitations or chest pain. These can feel like skipped heartbeats or a racing heart.
- Shortness of breath. If mild, it can mimic the shortness of breath commonly felt during the third trimester (or postpartum when you're recovering, busy with baby and sleep-deprived). More severe shortness of breath is what you want to keep an eye out for, especially if you experience it when lying down.
- Swelling in the feet and legs. This, too, is tough to distinguish from normal edema during pregnancy. If you have extreme, sudden, or unusual swelling, talk to your doctor. PPCM can cause the heart to pump improperly, and fluid can accumulate in the lower extremities. You may also notice swollen neck veins.
- Low blood pressure. Sometimes, women who get PPCM experience a drop in blood pressure when standing up (but not when they're seated or lying down). This might make you feel lightheaded.
Many PPCM symptoms mimic the signs of more benign conditions, which makes them easy to brush off — but it's important to talk to your doctor if you're experiencing any of them.
“I had cardiomyopathy after my firstborn,” recalls What to Expect Community user jennam249. “I had severe shortness of breath and had to go to the ER. My blood pressure had spiked, [and] I was extremely swollen. If you have any of these symptoms you should call your OB and go to the nearest emergency room.”
Staying on top of symptoms and doctor visits is key when managing a condition like PPCM — and during pregnancy in general. Use the What to Expect app's My Journal tool to log how you're feeling, track medications, and set reminders for appointments, all in one place.
When does peripartum cardiomyopathy typically surface?
PPCM can start any time during the last month of pregnancy or, more typically, within the first five to six months after delivery — but in around 75% of cases, it occurs within the first month of giving birth. Around 19% of diagnoses happen during the last month of pregnancy.[5]
The condition can be hard to detect because some of its symptoms — fatigue, swelling, shortness of breath, and so on — are very similar to those of the last trimester of pregnancy or early postpartum. That’s why it’s critical to talk to your doctor if you're experiencing any of these symptoms.
“The prognosis is best when peripartum cardiomyopathy is diagnosed and treated early,” says Andrei Rebarber, M.D., a board-certified OB/GYN with sub-specialty certification in Maternal Fetal Medicine, and member of the What to Expect Medical Review Board.
To diagnose PPCM, your practitioner will likely run some tests, such as both an electrocardiogram (ECG, an ultrasound of the heart) and echocardiogram.
PPCM risk factors and causes
It’s unclear what causes PPCM, but some evidence suggests there's a genetic component behind it. The risk factors most associated with developing peripartum cardiomyopathy include:[6]
- A history of PPCM in a previous pregnancy
- A history of heart issues, such as inflammation of the heart muscle (myocarditis) or small-vessel disease
- A history of smoking
- A history of alcoholism
- African-American descent
- Poor nutrition
- Obesity
- Carrying multiples
- Age (more than half of women who develop PPCM are over 30 years old)
- Preeclampsia or gestational hypertension
Other women may develop PPCM even if they don’t have any risk factors at all, though — so every new mom should be aware of the signs.
Treatments for peripartum cardiomyopathy
Treatment of PPCM focuses mainly on relieving the symptoms and preventing excess fluid from collecting in the lungs. Some remedies can be used to help the heart get back to normal. To treat peripartum cardiomyopathy, your practitioner may recommend the following:
Medications
Your doctor will consider the right medication for you depending on whether you’re still pregnant or have already delivered. Many are safe for breastfeeding moms — though, depending on the severity of the condition, your doctor may recommend that you not breastfeed. Types of medication used treat the symptoms and help the heart recover include:
- Digitalis to strengthen the heart
- ACE inhibitors to help the heart work efficiently
- Blood pressure medicine to give the heart time to heal
- Anticoagulants to help thin blood to reduce the risk of blood clots
- Diuretics to reduce fluid retention
Lifestyle changes
- Dietary changes, including salt restriction, to help treat the symptoms and heal the heart
- Stopping smoking or drinking alcohol
Is there any way to prevent peripartum cardiomyopathy?
There’s no way to prevent peripartum cardiomyopathy entirely, but you can reduce your risk by taking good care of your heart. That includes avoiding smoking and drinking excessively, eating a well-balanced diet, and getting regular exercise.
If you’ve had PPCM in one pregnancy, you’re at higher risk of developing it again in subsequent pregnancies — so it's especially important that you work closely with your medical team to determine if it’s safe for you to conceive again and whether you’ll need to take certain medications while you're expecting.
If someone in your family has had PPCM, it may also be worth asking your practitioner about genetic testing. “We often consider genetic counseling and testing in those with a positive family history of dilated cardiomyopathy, sudden death, or PPCM,” Dr. Rebarber says. “This is because approximately 10 to 20% of females with heart failure in the peripartum period carry mutations known to induce cardiomyopathies.” Sometimes people with these genetic abnormalities may have a predisposition to developing heart failure that is triggered by the physiological stress of pregnancy and delivery, he adds.
How can peripartum cardiomyopathy affect my pregnancy and me?
Women who develop severe peripartum cardiomyopathy toward the end of pregnancy will usually have their babies delivered right away. Moms-to-be with a less severe form of the disease will receive close monitoring, and may need to deliver early only if their condition becomes unstable.
Because most cases of PPCM occur after delivery, the biggest effect is on the health of the new mom. Approximately half of all women who develop PPCM recover completely, with their heart returning to normal with treatment, although it's still important for them to approach future pregnancies carefully.
For others, the heart may not be able to recover. In those cases, a future pregnancy could put a mom's life in danger, since it could result in heart failure. Other possible complications include cardiac arrhythmias (irregular heartbeats that could be dangerous) or blood clots.
Though peripartum cardiomyopathy is a serious condition, the available treatments can restore a new mom’s heart function and help her feel better.
Talk to your practitioner at any time during pregnancy or postpartum if you have questions, develop any worrisome symptoms, or are at all concerned about PPCM. And remember, though it's important to be vigilant about the warning signs, the chances that you'll have PPCM either during pregnancy or after your baby arrives are slim.
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