Women Can Confuse This Fatal Heart Condition With a Normal Pregnancy: How to Spot the Difference

You might have seen headlines recently linking fertility treatments to heart failure. That certainly sounds scary, especially if you’re a woman considering or currently undergoing IVF or other reproductive treatments. But before you worry too much, it’s important to understand all the facts—and know that this new finding may not be all it’s hyped up to be.

In a new study presented at the European Society of Cardiology’s Heart Failure 2019 conference in Greece this week, researchers announced that they’d found a link between a heart condition called peripartum cardiomyopathy (PPCM) and infertility. Women who’d had fertility treatments were five times more likely to suffer this type of heart failure, although the study did not find that one causes the other. Rather, the two conditions are linked, and both may be related to underlying fertility problems.

So how worried should couples trying to conceive be about this link? We spoke to an expert to find out.

First, a primer on PPCM: Peripartum cardiomyopathy, also called postpartum cardiomyopathy, is a form of heart failure that can strike during the last month of a woman’s pregnancy or up to five months postpartum.

According to the American Heart Association, the condition is rare, affecting between 1,000 and 1,300 women in the US each year. However, PPCM is more common in some other countries, and may be related to lifestyle and diet habits, as well as genetics or other medical conditions.

PPCM causes a woman’s heart to become enlarged and weak, and to malfunction. “The heart is being taxed and failing,” Lisa Becht, MD, fertility specialist at Columbia University Fertility Center in New York City, tells Health.

The appropriate treatment for PPCM depends on how severe a patient’s case is. Doctors will usually ask, “Is this urgent? Do we think delivering [the baby] would help them get better?” Dr. Becht says. But delivering a baby preterm might not be necessary. “Delivery might need to be done, [but] medications could improve [cardiac] function,” Dr. Becht explains.

If PPCM is not treated, however, it can be fatal for the mother—and also for the baby if it strikes during the last month of pregnancy.

Dr. Becht adds that if a woman suffers from PPCM during a pregnancy, she might be advised to avoid getting pregnant again. “If [the] heart couldn’t handle pregnancy the first time, they might want to consider a gestational carrier [the next time],” she says.

The research presented over the weekend analyzed data from 108 patients with PPCM, one-third of whom had a history of fertility problems. The researchers, from Hannover Medical School in Germany, found that there was a higher rate of babies born via IVF among study participants (13%) than in the general population of Germany (2.6%). Since all study participants had PPCM, this suggests that reduced fertility could be a risk factor for PPCM.

While the researchers did tie infertility to PPCM, they did not prove that infertility treatments such as IVF cause the condition. Rather, they found that you may be more likely to suffer from PPCM if you’re suffering from reduced fertility—possibly because of underlying shared risk factors or an unknown genetic predisposition. (The researchers did point out, however, that fertility treatments can increase the chances of a woman getting pregnant with multiples, which can therefore raise the risk of pregnancy-related heart problems.)

What makes PPCM especially dangerous is its ability to mimic pregnancy symptoms, says Dr. Becht. If you’re pregnant, you might not think much of swollen feet, fatigue, or the occasional difficulty breathing.

But these could all be signs of heart failure. Dr. Becht says that if a woman starts experiencing these symptoms, she should definitely consult her doctor. Patients could easily confuse PPCM for normal pregnancy symptoms, and, to make matters more complicated, “guidelines for when to start screening a female [for PPCM] can vary from fertility office to fertility office,” Dr. Becht says.

"Our study shows that the risk of PPCM is 5 times higher in women who have fertility treatment so they should be aware that this discomfort may not be benign,” study co-author Tobias Pfeffer, MD, cardiologist at Hannover Medical School, said in a press release. “PPCM is often diagnosed much too late, with direct consequences on prognosis,”

The research is a good reason for women to pay close attention to any warning signs during their last month of pregnancy, especially if they’ve had trouble conceiving. New moms should also keep an eye out in the months following their pregnancies, as PPCM can strike then too. “Pregnancy is a high-volume state—it’s really taxing the heart a lot,” Dr. Becht says. “[It] takes even up to a few months to get the body back.”

In conclusion, women shouldn’t panic over this new news just because they’re receiving IVF treatments, and they shouldn’t assume that such treatments will increase their risk of heart problems. And while this new study does suggest that infertility may be a risk factor for PPCM, more research is still needed before doctors know exactly what, or why, this connection exists. (Even the study in question has not been published in a peer-reviewed journal and should still be considered preliminary research.)

But just to be safe, it’s always a good idea to pay close attention to changes you notice in your body— yes, even during pregnancy—and talk to your doctor about any concerns you have.

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