Table 2

Summary of cardiac medication during and after pregnancy in dilated cardiomyopathy and peripartum cardiomyopathy

DrugPregnancyRecommendation during pregnancyRecommendation during breastfeedingPostpartum
ACE-I/ARBTeratogenic. 48% and 87% of fetuses exposed to ACE-I and ARB, respectively, had some type of complication.Contraindicated.22Captopril, benazepril and enalapril are considered safe.22
Data are limited for other preparation22
Used according to guidelines.26
ARNISee ACE-I/ARB.Contraindicated.22Limited data.22One case report with positive effect in PPCM.
Beta-blockersShall be used. Can give babies hypoglycaemia, bradycardia and small for gestational age. Metoprolol is recommended.22Metoprolol and carvedilol are considered safe.22 Atenolol is contraindicated.22Metoprolol: acceptable.22
Carvedilol: unknown.22
Used according to guidelines.26
MRASpironolactone have antiandrogenic effects.22 Eplerenone in high doses have caused postimplantation losses in rabbits.22Contraindicated.22Not recommended.22Used according to guidelines.26
DiureticsOligohydramnios and electrolyte disturbances and insufficient human data.38Furosemide and bumetanide are considered safe.22Furosemide, limited data, acceptable.22Used according to guidelines.26
InotropesLevosimendan is recommended in PPCM even if human data are inadequate.26Levosimendan may be preferred inotrope.26Unknown.22Used according to guidelines.26
VasodilatorsHydralazine 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.
IvabradineTeratogenic in animals.22Do not use.Unknown.22Positive effects in PPCM.
AnticoagulationLMWH if needed. Interrupted 4–6 hours before planned delivery.Considered safe.26Considered safe.26Continued 4–6 weeks postpartum34 and used according to guidelines.26
DigoxinPlacenta permeable. Safe.38Considered safe.22Minimal exposure.22Used according to guidelines.26
Bromocriptine2.5 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.