Pregnancy in women with hypertrophic cardiomyopathy: observational data from the tertiary referral center registry

Abstract

Introduction: The number of cases of hypertrophic cardiomyopathy (HCM) in pregnancy increases every year. In most cases the course of pregnancy is favorable, however in certain high-risk scenarios there is an increased risk of complications (e.g., increased ventricular ectopic activity, heart failure exacerbation). Management heavily relies on the severity of the outflow tract obstruction, extent of left ventricular hypertrophy and sudden cardiac death (SCD) risk stratification. Purpose: The main objective of this study is to assess risk factors and complications during pregnancy, childbirth and the postpartum period in women with HCM. Methods: In this retrospective study we included 60 pregnant women with HCM who were admitted to the tertiary referral center between October 2010 and December 2019 with a mean age of 29.1±5.19 years. ECHO was performed in all patients. Results: Twenty patients (33%) have obstructive HCM (HOCM), 31 patients (51,6%) were nulliparous, 20 patients (33%) had no clinical symptoms prior to pregnancy. Since the third trimester of pregnancy we observed the onset or exacerbation of heart failure in 26 (43.3%) cases, half of these patients presented with NYHA class III-IV. SCD risk was 3.64% (2.66 -5.84) in the third trimester. Six patients (9.23%) were required ICD implantation. Caesarean section (CS) delivery was performed in 38 patients (63.3%). However, the CS proportion has decreased from 80% to 51% in the last 5 years. Despite frequent complications during pregnancy and the postpartum period, no maternal mortality has been reported. The newborns' weight in HOCM cases was significantly lower than in patients without LVOT obstruction. Conclusion: Despite the favorable course of pregnancy in HCM patients, the third trimester of pregnancy was often accompanied by the onset and progression of heart failure, as well as an increase in the proportion of patients with ventricular arrhythmias. In patients with HOCM, a decrease in the weight of newborns was revealed.