Table 1.

Overview of potential medical therapies in peripartum cardiomyopathy

DrugSafety profile in pregnancySafety profile in lactationAbsence of full recovery of LV functionFully recovered LV function
DiureticsSafeThiazides best studiedContinue only for symptomatic reliefDiscontinue when asymptomatic
ACE inhibitorsRisk of damage to fetal renal systemRelatively safeEssentialContinue for at least 12 months
ARBTeratogenicLimited data so best avoidedRecommended in patients who cannot tolerate ACE inhibitorsContinue for at least 12 months
VasodilatorsUse with caution, may precipitate uterine hypoperfusionSafeContinue only for symptomatic reliefDiscontinue when asymptomatic
Beta blockersSafe, with metoprolol recommendedSafeEssentialContinue for at least 12 months
IvabradineNo data so best avoidedNo data so best avoidedAlternative to beta blocker therapy (if NSR), adjunct therapy if HR suboptimalDiscontinue when HR<75 bpm
MRANo data so best avoidedLimited data so best avoidedRecommended for patients with LVEF<40%Continue for at least 6 months

  • ACE = angiotensin-converting enzyme; ARB = angiotensin II receptor blocker; HR = heart rate; LVEF = left ventricular ejection fraction; MRA = mineralocorticoid receptor antagonists; NSR = normal sinus rhythm