Peripartum Cardiomyopathy and Dehydroepiandrosterone
James Michael Howard
(N Engl J Med 2001;344:1567-71)
This is my "letter to the editor" to the "New England Journal of Medicine."
I thought some, here, may be interested in reading it. (The abstract of the
article follows.)
James Michael Howard
Fayetteville, Arkansas, U.S.A.
"The findings of Elkayam, et al., may be explained by reduced
dehydroepiandrosterone (DHEA) in subsequent pregnancies. DHEA declines
"markedly and significantly" following a first pregnancy (J Clin Endocrinol
Metab 1987; 64: 111-8). DHEA levels in term nulliparous women requiring
pharmacologic augmentation are significantly lower than in women who
progress spontaneously through labor (Obstet Gynecol 1996; 88: 56-9). DHEA
is consistently connected to systolic blood pressure (Am J Hypertens 1999;
12: 1140-3) and "plasma levels of DHEAS are decreased in patients with CHF
in proportion to its severity" (J Clin Endocrinol Metab 2000; 85: 1834-40).
I suggest the conclusions of Elkayam, et al., represent a group of low DHEA
women whose first pregnancies further reduced their DHEA and, therefore,
associated peripartum cardiomyopathy."
This is the NEJM article:
"Maternal and Fetal Outcomes of Subsequent Pregnancies in Women with
Peripartum Cardiomyopathy"
Uri Elkayam, Padmini P. Tummala, Kalpana Rao, Mohammed W. Akhter, Ilyas S.
Karaalp, Omar R. Wani, Afshan Hameed, Israel Gviazda, Avraham Shotan
Abstract
Background. Peripartum cardiomyopathy is a rare but sometimes fatal form of
heart failure. Little is known about the outcomes of subsequent pregnancies
in women who have had the disorder.
Methods. Through a survey of members of the American College of Cardiology,
we identified 44 women who had had peripartum cardiomyopathy and had a total
of 60 subsequent pregnancies. We then reviewed the medical records of these
women and interviewed the women or their physicians.
Results. Among the first subsequent pregnancies in the 44 women, 28 occurred
in women in whom left ventricular function had returned to normal (group 1)
and 16 occurred in women with persistent left ventricular dysfunction (group
2). The pregnancies were associated with a reduction in the mean (ąSD) left
ventricular ejection fraction both in the total cohort (from 49ą12 percent
to 42ą13 percent, P<0.001) and in each group separately (from 56ą7 percent
to 49ą10 percent in group 1, P=0.002; and from 36ą9 percent to 32ą11 percent
in group 2, P=0.08). During these pregnancies, symptoms of heart failure
occurred in 21 percent of the women in group 1 and 44 percent of those in
group 2. The mortality rate was 0 percent in group 1 and 19 percent in group
2 (P=0.06). In addition, the frequency of premature delivery was higher in
group 2 (37 percent vs. 11 percent), as was that of therapeutic abortions
(25 percent vs. 4 percent).
Conclusions. Subsequent pregnancy in women with a history of peripartum
cardiomyopathy is associated with a significant decrease in left ventricular
function and can result in clinical deterioration and even death. (N Engl J
Med 2001;344:1567-71.)"