Postpartum Cardiomyopathy and Considerations for Breastfeeding

Abstract

Postpartum cardiomyopathy (PPCM) is a rare condition that develops near the end of pregnancy or in the months after giving birth, manifesting as heart failure secondary to left ventricular systolic dysfunction. Clinical progression varies considerably, with both end-stage heart failure occurring within days and spontaneous recovery seen. Treatment pathways for heart failure are well established, but the evidence about the safety of medicines passed to infants during breastfeeding is scarce and mainly poor; this often leads to an incorrect decision that a mother should not breastfeed. Given its benefits to both mother and infant, breastfeeding should not routinely be ruled out if the mother is taking heart failure medication but the consequences for the infant need to be considered. An informed risk assessment to minimise potential harm to the infant can be carried out using the evidence that is available along with a consideration of drug properties, adverse effects, paediatric use and pharmacokinetics. In most cases, risks can be managed and infants can be monitored for potential problems. Breastfeeding can be encouraged in women with cardiac dysfunction with PPCM although treatment for the mother takes priority with breastfeeding compatibility being the secondary consideration. International research is continuing to establish efficacy and safety of pharmacotherapy in PPCM.

Management Considerations in Complicated Peripartum Cardiomyopathy

“…However, when PPCM is suspected from the patient's clinical presentation, immediate instigation of labs and an echocardiogram should be performed to confirm the diagnosis and begin management. Although our patient did not reach the clinical criteria to diagnose preeclampsia, the symptoms of headache, rapid weight gain (10 lb in a week), edema, proteinuria, elevation of hepatic enzymes with mild elevation of BP, should alert the obste-there is little literature on its use and effects in peripartum and postpartum patients [18,19]. Based on the properties of its drug class and pharmacokinetics, sacubitril/valsartan is generally contraindicated or should be used with caution in this patient population [19,20].…”

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“…Although our patient did not reach the clinical criteria to diagnose preeclampsia, the symptoms of headache, rapid weight gain (10 lb in a week), edema, proteinuria, elevation of hepatic enzymes with mild elevation of BP, should alert the obste-there is little literature on its use and effects in peripartum and postpartum patients [18,19]. Based on the properties of its drug class and pharmacokinetics, sacubitril/valsartan is generally contraindicated or should be used with caution in this patient population [19,20]. Its administration, therefore, was considered on a caseby-case basis.…”

Diabetic nephropathy in pregnancy: Report of two cases progressing to end-stage renal disease within one year postpartum

“…Although contraindicated in pregnancy due to their effects on the fetus, these medications should be initiated postpartum [ 15 ]. Many of these agents, however, have been noted in very small quantities in breast milk [ 16 ]. Enalapril is often the preferred option since it has the most published data supporting its use.…”

“…Enalapril is often the preferred option since it has the most published data supporting its use. One study calculated the level of infant exposure to enalapril as 0.16% of the maternal weight-adjusted dose [ 16 ]. Given the clinically demonstrated benefit of RAAS blockade, a risk/benefit discussion regarding their usage should be held during breastfeeding period.…”