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PubMed This is a summary of 17 peer-reviewed journal articles Updated
Cardiology

Looking Ahead: Future Pregnancies and Family Planning

At a Glance

After a peripartum cardiomyopathy (PPCM) diagnosis, subsequent pregnancies carry a high risk of relapse, even if heart function has fully recovered. Women with persistent heart impairment should avoid pregnancy. Safe, estrogen-free contraception and a cardio-obstetrics evaluation are essential.

Thinking about the future after a Peripartum Cardiomyopathy (PPCM) diagnosis is often a mix of relief and anxiety. While many women recover their heart function, the question of “Can I have another baby?” is one of the most complex and emotionally charged decisions you may face. It is a decision that requires a clear understanding of the risks and a specialized medical team to guide you [1][2].

The Risk of Relapse

The most critical thing to understand is that PPCM carries a high risk of relapse in subsequent pregnancies [1][3]. Even if your Ejection Fraction (EF) has completely returned to normal, the physiological stress of a new pregnancy can cause the heart muscle to weaken again [1][4].

Heart Function Status Risk Level Possible Outcomes
Fully Recovered EF ($\ge$50%) Moderate to High While many have favorable outcomes, there is still a risk of a transient drop in EF or a full relapse into heart failure [4][2].
Persistent Impairment (<50%) Very High / Dangerous Pregnancy is generally strongly discouraged. There is a very high risk of severe heart failure, the need for a heart transplant, or maternal death [5][6].

Making an Informed Decision

If you are considering a future pregnancy, you should not make the decision alone. A Cardio-Obstetrics team—a group of cardiologists and high-risk pregnancy specialists (Maternal-Fetal Medicine)—will perform a “pre-conception risk stratification” [7][8].

They will look at:

  1. Stability: Has your heart function been normal and stable for at least 6 to 12 months off or on stable medications? [9][10]
  2. Cardiac Reserve: How does your heart respond to stress? (Often measured by a stress echocardiogram) [11].
  3. Biomarkers: Are your NT-proBNP levels consistently low? [12].

For mothers who fall into the “Very High / Dangerous” risk category, or those who choose not to accept the risk of relapse, exploring alternative family-building options such as surrogacy or adoption can be a fulfilling way to grow your family while protecting your life.

Family Planning and Contraception

Because an unintended pregnancy can be life-threatening if your heart is not ready, reliable contraception is a vital part of survivorship [7][13].

  • Avoid Estrogen: Combined hormonal contraceptives (like “the Pill”) that contain estrogen are generally avoided for PPCM survivors. Estrogen can increase the risk of blood clots, which is already a concern for women with a history of heart failure [14].
  • Preferred Options: Long-acting reversible contraceptives (LARCs), such as a copper IUD or progestin-only implants and shots, are often recommended because they are highly effective and do not carry the same clotting risks [2][7].

Life as a Survivor

Survivorship means more than just monitoring your heart; it means taking care of your whole self. Many PPCM survivors experience long-term symptoms like fatigue, anxiety, or “cardiac PTSD” [15][16].

Remember: Your health is the foundation of your family. Whether you choose to pursue another pregnancy or focus on the child(ren) you have, your primary goal is to remain healthy and present. Stay connected with your cardiology team, advocate for regular check-ups, and prioritize your well-being [17][9].

Common questions in this guide

Can I have another baby after being diagnosed with PPCM?
Having another baby after PPCM carries a high risk of heart failure relapse. If your heart function has not fully recovered, pregnancy is strongly discouraged due to severe risks. You should consult a cardio-obstetrics team to carefully assess your specific situation before getting pregnant again.
Will my heart failure come back if my ejection fraction is normal?
Even if your ejection fraction has completely returned to normal, the physical stress of a new pregnancy can still cause your heart muscle to weaken again. While outcomes may be favorable, there remains a moderate to high risk of relapse or a temporary drop in heart function.
What birth control is safe for PPCM survivors?
PPCM survivors should generally avoid birth control containing estrogen because it increases the risk of blood clots. Long-acting reversible contraceptives (LARCs), such as copper IUDs or progestin-only implants and shots, are typically recommended as safer, highly effective alternatives.
What tests are needed before I consider getting pregnant after PPCM?
Your doctor will likely perform a pre-conception risk assessment to evaluate your heart's stability. This often includes a stress echocardiogram to see how your heart handles extra workload and blood tests to ensure your NT-proBNP biomarkers are consistently low.

Questions for Your Doctor

5 questions

  • •Given my history of PPCM, what is my specific statistical risk of heart failure relapse if I were to become pregnant again?
  • •Should I have a stress echocardiogram to see how my heart handles a simulated 'workload' before I consider another pregnancy?
  • •If I decide not to have more children, which long-acting reversible contraceptives (LARCs) do you recommend that won't increase my risk of blood clots?
  • •Can you refer me to a Cardio-Obstetrics team for a formal pre-conception risk assessment?
  • •If I do become pregnant, how frequently will my heart function be monitored, and what medications will I need to be on for protection?

Questions for You

3 questions

  • •How did I handle the physical and emotional stress of my first PPCM diagnosis, and am I prepared to face that risk again?
  • •What is my 'safety threshold'—what level of risk to my own life am I willing to accept to have another biological child?
  • •Have I discussed the possibility of a relapse with my partner and family, and do we have a support plan in place?

References

References (17)
  1. 1

    Outcome of subsequent pregnancies in patients with a history of peripartum cardiomyopathy.

    Hilfiker-Kleiner D, Haghikia A, Masuko D, et al.

    European journal of heart failure 2017; (19(12)):1723-1728 doi:10.1002/ejhf.808.

    PMID: 28345302
  2. 2

    Peripartum Cardiomyopathy.

    Shrikhande L, Shrikhande A, Shrikhande B

    Journal of obstetrics and gynaecology of India 2022; (72(5)):377-381 doi:10.1007/s13224-022-01621-2.

    PMID: 36458061
  3. 3

    Long-Term Outcomes of Women With Peripartum Cardiomyopathy Having Subsequent Pregnancies.

    Pachariyanon P, Bogabathina H, Jaisingh K, et al.

    Journal of the American College of Cardiology 2023; (82(1)):16-26 doi:10.1016/j.jacc.2023.04.043.

    PMID: 37380299
  4. 4

    Subsequent Pregnancy Outcomes in Patients With Peripartum Cardiomyopathy.

    Codsi E, Rose CH, Blauwet LA

    Obstetrics and gynecology 2018; (131(2)):322-327 doi:10.1097/AOG.0000000000002439.

    PMID: 29324614
  5. 5

    Racial disparities in peripartum cardiomyopathy: eighteen years of observations.

    Sinkey RG, Rajapreyar IN, Szychowski JM, et al.

    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2022; (35(10)):1891-1898 doi:10.1080/14767058.2020.1773784.

    PMID: 32508175
  6. 6

    Peripartum cardiomyopathy: An analysis of clinical profiles and outcomes from a tertiary care centre in southern India.

    Binu AJ, Rajan SJ, Rathore S, et al.

    Obstetric medicine 2020; (13(4)):179-184 doi:10.1177/1753495X19851397.

    PMID: 33343694
  7. 7

    Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy.

    Bauersachs J, König T, van der Meer P, et al.

    European journal of heart failure 2019; (21(7)):827-843 doi:10.1002/ejhf.1493.

    PMID: 31243866
  8. 8

    Peripartum cardiomyopathy: approach to management.

    Goland S, Elkayam U

    Current opinion in cardiology 2018; (33(3)):347-353 doi:10.1097/HCO.0000000000000516.

    PMID: 29601327
  9. 9

    Living with peripartum cardiomyopathy: A statement from the Heart Failure Association and the Association of Cardiovascular Nursing and Allied Professions of the European Society of Cardiology.

    Sliwa K, Rakisheva A, Viljoen C, et al.

    European journal of heart failure 2024; (26(10)):2143-2154 doi:10.1002/ejhf.3377.

    PMID: 39115028
  10. 10

    The Advances in Utilizing Right Ventricular Function as a Predictor of Peripartum Cardiomyopathy Recovery: A Single Centre Prospective Cohort Study.

    Akbar MR, Sakasasmita S, Achmad C, et al.

    International journal of general medicine 2025; (18()):299-308 doi:10.2147/IJGM.S477008.

    PMID: 39867249
  11. 11

    Persistence of abnormal global longitudinal strain in women with peripartum cardiomyopathy.

    Bortnick AE, Lama von Buchwald C, Hasani A, et al.

    Echocardiography (Mount Kisco, N.Y.) 2021; (38(6)):885-891 doi:10.1111/echo.15071.

    PMID: 33963787
  12. 12

    Predictors of early and delayed recovery in peripartum cardiomyopathy: a prospective study of 52 Patients.

    Biteker M, Özlek B, Özlek E, et al.

    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2020; (33(3)):390-397 doi:10.1080/14767058.2018.1494146.

    PMID: 29945487
  13. 13

    Peripartum cardiomyopathy, what if your patient plans to reconceive?

    Al Bannay R, Husain A, AlJufairi Z

    Clinical case reports 2017; (5(6)):753-756 doi:10.1002/ccr3.935.

    PMID: 28588804
  14. 14

    One-Year Cardiovascular Outcomes in Patients With Peripartum Cardiomyopathy.

    Dayoub EJ, Datwani H, Lewey J, Groeneveld PW

    Journal of cardiac failure 2018; (24(10)):711-715 doi:10.1016/j.cardfail.2018.08.005.

    PMID: 30194024
  15. 15

    Psychological adaptation after peripartum cardiomyopathy: A qualitative study.

    de Wolff M, Ersbøll AS, Hegaard H, et al.

    Midwifery 2018; (62()):52-60 doi:10.1016/j.midw.2018.03.012.

    PMID: 29655005
  16. 16

    Post-Traumatic Stress, Depression, and Quality of Life in Women with Peripartum Cardiomyopathy.

    Donnenwirth JA, Hess R, Ross R

    MCN. The American journal of maternal child nursing 2020; (45(3)):176-182 doi:10.1097/NMC.0000000000000614.

    PMID: 32341249
  17. 17

    Management of Heart Failure and Cardiogenic Shock in Pregnancy.

    Sharma S, Thomas SS

    Current treatment options in cardiovascular medicine 2019; (21(12)):83 doi:10.1007/s11936-019-0797-1.

    PMID: 31820124

This page provides educational information on family planning and pregnancy risks after peripartum cardiomyopathy. It does not replace professional medical advice from your cardio-obstetrics team. Always consult your doctors before making decisions about future pregnancies or contraception.

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