Table 2.
Summary of cardiac medication during and after pregnancy in dilated cardiomyopathy and peripartum cardiomyopathy
| Drug | Pregnancy | Recommendation during pregnancy | Recommendation during breastfeeding | Postpartum |
| ACE-I/ARB | Teratogenic. 48% and 87% of fetuses exposed to ACE-I and ARB, respectively, had some type of complication. | Contraindicated.22 | Captopril, benazepril and enalapril are considered safe.22
Data are limited for other preparation 22 |
Used according to guidelines.26 |
| ARNI | See ACE-I/ARB. | Contraindicated.22 | Limited data.22 | One case report with positive effect in PPCM. |
| Beta-blockers | Shall be used. Can give babies hypoglycaemia, bradycardia and small for gestational age. Metoprolol is recommended.22 | Metoprolol and carvedilol are considered safe.22 Atenolol is contraindicated.22 | Metoprolol: acceptable.22
Carvedilol: unknown.22 |
Used according to guidelines.26 |
| MRA | Spironolactone have antiandrogenic effects.22 Eplerenone in high doses have caused postimplantation losses in rabbits.22 | Contraindicated.22 | Not recommended.22 | Used according to guidelines.26 |
| Diuretics | Oligohydramnios and electrolyte disturbances and insufficient human data.38 | Furosemide and bumetanide are considered safe.22 | Furosemide, limited data, acceptable.22 | Used according to guidelines.26 |
| Inotropes | Levosimendan is recommended in PPCM even if human data are inadequate.26 | Levosimendan may be preferred inotrope.26 | Unknown.22 | Used according to guidelines.26 |
| Vasodilators | Hydralazine and high-dose long-acting nitrates are recommended.26 Hydralazine is teratogenic in mice. | Conflicting data. | Hydralazine: considered safe.22
Isosorbide dinitrate: unknown.22 |
Change to ACE-I/ARB/ARNI. |
| Ivabradine | Teratogenic in animals.22 | Do not use. | Unknown.22 | Positive effects in PPCM. |
| Anticoagulation | LMWH if needed. Interrupted 4–6 hours before planned delivery. | Considered safe.26 | Considered safe.26 | Continued 4–6 weeks postpartum34 and used according to guidelines.26 |
| Digoxin | Placenta permeable. Safe.38 | Considered safe.22 | Minimal exposure.22 | Used according to guidelines.26 |
| Bromocriptine | – | 2.5 mg ×1 in 1 week in mild PPCM, 2.5 mg ×2 in 2 weeks and 2.5 mg ×1 in 6 weeks if EF <25% or cardiogenic chock, combined with anticoagulation.26 |
ACE-I, ACE inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor neprilysin inhibitor; EF, ejection fraction; LWMH, low weight molecular heparin; MRA, mineral corticoid receptor antagonist; PPCM, peripartum cardiomyopathy.