Greater gestational weight gain (GWG) may be a risk factor for peripartum cardiomyopathy (PPCM). In counseling, women with a prior history of PPCM associated with greater GWG should be advised to avoid excessive GWG in subsequent pregnancies. The third pregnancy occurred in a 36-year-old Japanese woman with height of 1.48 m and left ventricular ejection fraction (LVEF) of 62% following the first and second pregnancies complicated with PPCM and spontaneous abortion, respectively. She exhibited GWG of 14.7 kg (from 37.0 to 51.7 kg) and normal or nearly normal plasma B-type natriuretic peptide levels and LVEF (>55%) throughout the current pregnancy. In her first pregnancy at the age of 33 years, extraordinary GWG of 30 kg (from 38.5 to 69.1 kg) preceded PPCM with nadir LVEF of 22% at 6 weeks postpartum followed by more than 18-month LVEF of <55%.

Peripartum cardiomyopathy (PPCM) is defined as by the European Society of Cardiology as follows: “idiopathic cardiomyopathy presenting with heart failure (HF) secondary to left ventricular (LV) systolic dysfunction toward the end of pregnancy or in the months following delivery, where no other cause of HF is found.” It is a diagnosis of exclusion. The LV may not be dilated but the left ventricular ejection fraction (LVEF) is nearly always reduced below 45%”. PPCM occurs in 0.03% to 0.3% of pregnant women  with a mortality rate ranging from 4% to 15%. Recovery of LVEF (>50%) occurs in approximately 50% of patients within 6 months, but the risk of recurrence of HF in subsequent pregnancies is high in the group where the LVEF has not normalized before the subsequent pregnancy; in the subsequent pregnancies of 16 women with persistent left ventricular dysfunction (LVEF<50%), the mean LVEF (±SD) decreased from 36 ± 9% to 32 ± 11%, symptoms of heart failure occurred in 44% (7/16), and 19% (3/16) died. In counselling, advice against a subsequent pregnancy is recommended in women with LVEF of ≤25% at diagnosis of PPCM or where the LVEF has not normalized. The presenting symptoms in PPCM patients include dyspnea, orthopnea, tachycardia, and peripheral edema. The common presenting symptoms, such as dyspnea, orthopnea, and peripheral edema, suggest excessive water retention in patients with PPCM, and greater gestational weight gain (GWG) preceded PPCM exclusively in our previous three PPCM cases encountered over the past decade. One of these women became pregnant again 2.5 years later. This case was followed up carefully with respect to cardiac function and GWG, and suggested that limiting GWG was effective in the avoidance of PPCM recurrence. This case is presented with the consent of the patient and approval of the institutional review board of Hokkaido University Hospital. All work was conducted in accordance with the Declaration of Helsinki.

With Regards,
Sara Giselle
Associate Managing Editor    
Journal of Critical Care Obsestrics & Gynocology