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pregnancy...nov. 2002

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Lisa Salberg Find out more about Lisa Salberg
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  • pregnancy...nov. 2002

    Nov 19, 2002
    Pregnancy may be safe for women with HCM
    Bethesda, MD - A new study suggests that young women with hypertrophic cardiomyopathy (HCM) may be able to safely consider pregnancy. In a series of almost 200 pregnancies in women with HCM, there were 2 deaths, both in women with the most severe form of the disease, both of whom had been counseled against risking pregnancy. The report appears in the November 20, 2002 issue of the Journal of the American College of Cardiology.[1]

    "It would appear that death is uncommon and is confined to women who have severe manifestations of the disease, which means that all the others can be reassured with some data that they can face a pregnancy," said Dr Paolo Spirito (Ente Ospedaliero Ospedali Galliera, Genoa, Italy) in a release from the American College of Cardiology (ACC).

    The findings underline the growing impression that the majority of cases of HCM, many of them asymptomatic cases found through genetic screening of families of index cases, are at lower risk than previously thought, the researchers note. "This article provides more compelling evidence that HCM is less deadly than earlier articles suggested and confers reassurance to physicians caring for pregnant HCM women or those contemplating pregnancy that the odds are strongly in favor of a successful outcome," said Dr John Michael Criley (Harbor-UCLA Medical Center), who was not involved in this research, also in the ACC release.

    Better diagnosis means growing numbers
    Genetic screening of families affected with HCM and the increasing use of echocardiography has led to identification of a growing number of young women previously unaware they had the condition, the researchers write. The few studies on the course of pregnancy in women with HCM were performed more than 20 years ago, in small, selected populations and reported no deaths, they point out, yet several case reports have described severe cardiac complications and death during pregnancy in these women.

    In this study, the researchers assessed pregnancy-related mortality in 91 families with HCM evaluated at 3 Italian centers and then compared that figure with what might be expected in the general Italian population, the last available figures for which were from 1955. Accordingly, the cohort included 199 live births to 100 women with HCM, all after 1954.

    They also considered pregnancies in an additional 96 members of these families who had not been assessed for HCM to try to prevent underestimation of maternal mortality because of a missed diagnosis.

    Pregnancy-associated morbidity was also assessed in 40 women who were evaluated within 5 years of their pregnancy.

    Progression of symptoms
    Among the 100 women with HCM, 2 deaths occurred, in particularly high-risk patients. The maternal mortality rate was 10 per 10 000 live births (95% CI 1.1-36.2/1000). This rate was still in excess of expected mortality in the general population, with a relative risk of 17.1 (95% CI 2.0-61.8). No additional deaths were seen in the expanded family cohort.

    Of the 40 women assessed for morbidity, 1 of 28 women (4%) who had been asymptomatic before their pregnancy and 5 of 12 (42%) who had had symptoms progressed to functional class 3 or 4 during their pregnancy (p<0.001).

    One patient had atrial fibrillation and 1 had syncope; both women had already experienced similar symptoms before their pregnancy.

    "Our results indicate that the risk of death during pregnancy is increased in patients with HCM compared with the general population," they conclude. "However, our findings show that absolute maternal mortality is low and appears to be principally confined to women who are at particularly high risk."
    Knowledge is power ... Stay informed!
    YOU can make a difference - all you have to do is try!

    Dx age 12 current age 46 and counting!
    lost: 5 family members to HCM (SCD, Stroke, CHF)
    Others diagnosed living with HCM (or gene +) include - daughter, niece, nephew, cousin, sister and many many friends!
    Therapy - ICD (implanted 97, 01, 04 and 11, medication
    Currently not obstructed
    Complications - unnecessary pacemaker and stroke (unrelated to each other)
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