Author + information
- Maarten P. van den Berg, MD, PhD⁎ (, )
- Karin Y. van Spaendonck-Zwarts, MD and
- Dirk J. van Veldhuisen, MD, PhD
- ↵⁎Department of Cardiology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
In a recent issue of the Journal, Grewal et al. (1) showed that the risk of adverse maternal events in pregnant women with dilated cardiomyopathy (DCM) is considerable, but the underlying mechanisms (in addition to increased hemodynamic load) remain uncertain. Medication was discontinued in many of the women before pregnancy or during the first trimester. Even without the physical burden of pregnancy, withdrawal of heart failure medication per se may lead to dramatic hemodynamic deterioration. It thus would be interesting to know whether the pregnant women whose medication was discontinued fared worse than those who continued to take their normal medication. It should be noted that several beta-blockers, notably labetalol, can be used safely during pregnancy. Thus, pregnancy outcome may not be quite as dismal as reported by Grewal et al. (1) when adequate therapy is provided.
Four of the 9 cases of heart failure occurred after delivery (1). Oxidative stress rises during normal pregnancy, culminating in the last trimester. Several signaling pathways have been shown to be necessary for protecting the maternal heart, including STAT3. In a mouse model, a deletion of STAT3caused proteolytic cleavage of prolactin into a potent antiangiogenic, proapoptotic, and proinflammatory factor associated with the development of peripartum cardiomyopathy (2). It is conceivable that peripartum oxidative stress caused additional damage to the left ventricle. In this respect, the fact that 5 women had doxorubicin-induced DCM may be relevant, because oxidative stress is deemed to play an important role in this type of DCM. It thus would be interesting to know whether Grewal et al. (1) found a difference in pregnancy outcome between the women with doxorubicin-induced DCM versus idiopathic DCM.
- American College of Cardiology Foundation