Peripartum Cardiomyopathy: What You Need to Know About Heart Disease After Childbirth

Michelle Routhenstein, MS, RD, CDE

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November 14, 2024

Peripartum cardiomyopathy is a rare cause of cardiomyopathy that occurs during late pregnancy or soon after childbirth. Cardiomyopathy is a condition where the heart muscle becomes weakened, enlarged, or stiff, making it harder for the heart to pump blood effectively. It can lead to heart failure, irregular heartbeats, and other complications.

Some possible symptoms include shortness of breath during sleep, trouble breathing when moving around or lying flat, swollen feet and ankles, dry cough, postpartum palpitations, chest pain, or increased abdominal girth. 

There aren’t cardiomyopathy biomarkers, as postpartum cardiomyopathy is a diagnosis of exclusion. In other words, there aren’t tests that specifically diagnose postpartum cardiomyopathy — so providers may rule out other things first. 

However, your provider should be monitoring levels of the hormone B-type natriuretic peptide (BNP) in your blood postpartum, as higher-than-normal BNP can be a sign that your heart isn’t working as it should. Women who have just had a baby should get a BNP test postpartum to help diagnose this more timely. If your provider doesn’t bring it up, ask them about it. 

Let’s take a closer look at the risk factors for developing peripartum cardiomyopathy and the best approaches to management. 

Risk Factors

Anyone who has a baby can be at risk for developing postpartum cardiomyopathy, but several factors can increase your risk:

  • Obesity
  • Selenium and zinc deficiency
  • Hypertension
  • Diabetes
  • Substance use disorder
  • African descent
  • Over 30 years old
  • First-time pregnancy
  • Having a previous diagnosis of peripartum cardiomyopathy
  • Becoming pregnant with the use of IVF
  • Multiparity (pregnant with twins or triplets)
  • Multiple gestations
  • Prolonged use of tocolytics
  • Having iron deficiency anemia, thyroid disease, or an asthma or autoimmune disease flareup during pregnancy

This condition usually starts to appear toward the end of pregnancy or during the first few months postpartum. It’s also important to be aware that symptoms of postpartum cardiomyopathy can be confused with signs of normal pregnancy. This can result in missed signs, delayed diagnosis, and a higher risk of complications. 

Lifestyle Management of Postpartum Cardiomyopathy

The most important thing you can do to manage postpartum cardiomyopathy, in addition to taking any prescribed medications as directed, is to consider how you can make improvements to your everyday lifestyle. 

Nutrition

Nutrition for postpartum cardiomyopathy is more than the generic “healthy eating” advice you might receive from a healthcare provider. While eating well is part of it, it’s important to understand the details when it comes to the nutritional quality and beneficial components of what you’re eating. 

One of the most important areas to focus on in your diet pattern is antioxidants. Research shows that oxidative stress and inflammation may be key components of the development and progression of postpartum cardiomyopathy. 

Antioxidants are substances that help neutralize free radicals, harmful substances that can accumulate in the body and cause oxidative stress that leads to damage and disease. They help protect cellular health which, in turn, helps keep excess stress and inflammation in check. 

Some of the best compounds to highlight in your diet, which have antioxidant and anti-inflammatory properties, include: 

Isoflavones

Isoflavones are plant compounds (specifically phytoestrogens), primarily found in soy products, that mimic estrogen in the body and have antioxidant effects. They may be beneficial for postpartum cardiomyopathy by supporting heart health through their ability to reduce inflammation and improve blood vessel function. Common sources include soybeans, tofu, tempeh, and soy milk.

Sulfur containing foods

Sulfur-containing compounds, like allicin and sulforaphane, have potent antioxidant and anti-inflammatory properties. They help protect against heart dysfunction and reduce oxidative stress. Find them in garlic, onions, broccoli, and Brussels sprouts.

Polyphenols

Polyphenols may help with postpartum cardiomyopathy by reducing oxidative stress and inflammation. Find polyphenols in plant foods like berries, dark chocolate, green tea, and red wine.

Medications 

Peripartum cardiomyopathy is treated in a similar way as other forms of cardiomyopathy. However, managing the condition may be different depending on if the condition occurs before or after the baby is born. Either way, the goal of treatment is to reduce extra fluid from collecting in the lungs to help keep pressure off of the heart.

Some medications commonly prescribed to help manage the condition include: 

  • ACE (angiotensin-converting enzyme) inhibitor. This type of medication can help dilate your blood vessels allowing your heart to work more efficiently. ACE inhibitors cannot be used during pregnancy as they can negatively affect your baby’s kidneys; therefore, your doctor will need to look for an alternative if it starts during pregnancy.
  • Beta-blockers. These can be used during pregnancy to help decrease your heart rate and blood pressure.
  • Diuretics. AKA “water pills”, these are used to help manage symptoms of postpartum cardiomyopathy by helping to reduce fluid retention. They can be used during or after pregnancy.

Note that while adhering to your prescribed medications for postpartum cardiomyopathy is essential, these may not be medications you will be on forever. Work with your whole team, including a cardiovascular dietitian, to improve the nutritional quality of your diet pattern alongside using necessary medications. 

Furthermore, some of these drugs may have nutritional implications that aren’t always covered when they’re prescribed, so it’s important to have a team that understands how to mitigate these risks. For example, some of these medications can deplete or hold onto essential micronutrients which can impact optimal heart health. 

Peripartum Cardiomyopathy Stress Management Tips

New moms will agree that the period after giving birth (sometimes called “fourth trimester”) can be much more challenging, busy, and stressful than anticipated. While there’s so much emphasis on caring for your new baby (which is important, of course), the health of the mom also needs to be prioritized. 

Some of the best ways to support your mental, emotional, and physical health after childbirth include: 

  • Sleep: Sleep is crucial for new moms because it supports recovery from childbirth, balances hormones, and improves mood and energy, all of which are essential for managing the demands of caring for a newborn. To help meet sleep needs, try napping when the baby naps, ask for help with nighttime feedings, and create a calming bedtime routine to wind down when possible.
  • Mental health support: Mental health support is vital for new moms because the postpartum period can bring emotional challenges like anxiety, depression, and overwhelm, which can impact both mom and baby. To meet her mental health needs, a new mom can reach out to a therapist, join support groups for new mothers, and lean on friends and family for emotional support and breaks when needed.
  • Physical activity (when cleared): Physical activity is important for new moms because it helps boost energy, improve mood, and support physical recovery from childbirth. To fit in exercise, a new mom can start with gentle activities like walking with the baby in a stroller, doing short workouts during nap time, or incorporating simple stretching into daily routines.

As a mom to 4 boys myself, I realize that some of this is easier said than done, and it’s not going to be achievable in every season. Do the best you can to ensure you’re receiving the postpartum support you need — asking for help will become really important. 

Cardiomyopathy Post Pregnancy: Long-Term Support

Finding the right support and evidence-based information can help protect your heart, protect your baby, and reduce your risk of heart complications down the road.

In my 6-week heart optimization group program, I guide you on how to implement science-based heart health strategies to improve your heart health, while being a part of a supportive community of individuals who may be going through a similar journey as you are.

If you’re pregnant or have been diagnosed with peripartum cardiomyopathy, you may benefit from meeting 1 on 1 with a registered dietitian who specializes in heart disease. With my extensive experience in cardiovascular care and as a mother myself, I can develop a science-based individualized plan to help you achieve your goals to stay healthy during pregnancy and beyond. 

Click here to book a complimentary 15-minute discovery call to see if we’re a good fit to work together.

Sources

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