title: Safe and Effective Use of Pharmacologic and Device Therapy for Peripartum Cardiomyopathy.
abstract: Peripartum cardiomyopathy (PPCM) is an uncommon, idiopathic complication of pregnancy associated with significant (10-30%) mortality. The disease occurs late in pregnancy or in the months following delivery, resulting in reduced systolic function and heart failure (HF) symptoms. Limited direction is provided for the management of PPCM, and the safe and effective use of medications in pregnant and breastfeeding women with PPCM presents a unique challenge. Although several HF therapies in pregnant and lactating women are supported by robust evidence, evidence to support the use of other therapies is significantly lacking. Current guidelines recommend treatment as in other forms of HF with reduced left ventricular ejection fraction (LVEF) but with consideration for the important nuances in this population as well as the unique and potential teratogenic effects of these therapies. Since most patients with PPCM recover their LVEF, the duration of therapy is currently unknown and warrants further study. We review the available literature surrounding pharmacologic and device therapy for PPCM and provide insight into managing patients with the condition.
authors.affiliation: Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Laliberte
authors.affiliation: Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland. breed@rx.umaryland.edu.
authors.forename: Brent N
authors.initials: BN
authors.lastname: Reed
authors.affiliation: Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Ather
authors.affiliation: Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Devabhakthuni
authors.affiliation: Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland.
authors.forename: Kristin
authors.initials: K
authors.lastname: Watson
authors.affiliation: Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland.
authors.forename: Allison B
authors.initials: AB
authors.lastname: Lardieri
authors.affiliation: Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Carissa M
authors.initials: CM
authors.lastname: Baker-Smith
mesh_terms: D009202:Cardiomyopathies / Q000209:etiology / Q000628:therapy*; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007774:Lactation; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology / Q000628:therapy*; D013599:Systole; D018487:Ventricular Dysfunction, Left
keywords: heart failure; lactation; medication safety; peripartum cardiomyopathy; pregnancy; pregnancy complications; women's health