Drug

Comments

Safety during pregnancy

Safety during lactation

Potential adverse effects

Diuretic agents (loop diuretics, thiazide diuretics)

Loop diuretics are first-line agents for volume control. Thiazides can be added as second-line agents

Safe

Safe

Avoid overdiuresis to prevent reductions in fetal blood flow in pregnant patients

Hydralazine/
nitrates

First-line vasodilators also used instead of ACEIs/ARBs in antepartum period. Typically added as an adjunct to diuretic therapy

Safe

Safe

Potential for maternal hypotension resulting in placental hypoperfusion

Beta-blockers

Indicated for LV dysfunction (EF <45%) to improve myocardial contractility and reduce risk of arrhythmia

Safe

Safe

Fetal bradycardia or hypoglycemia. Avoid in acute decompensated HF

ACEIs/
ARBs

Indicated in postpartum period for patients with LV dysfunction; confer survival benefit

Not safe

Safe

Risk of teratogenicity in pregnancy (renal agenesis, oligohydramnios, fetal demise)

Aldosterone antagonists

Indicated in postpartum period for patients with LV dysfunction; confer survival benefit in patients with NYHA class III-IV

Not safe

Safe

Undervirilization of fetus

Bromocriptine

Used based on theory that elevations in prolactin levels correlate with timing to peak incidences of PPCM. Bromocriptine acts to inhibit prolactin. Consider in patients with EF <30% or requiring advanced managementEvidence 1Weak recommendation (benefits likely outweigh downsides, but the balance is close or uncertain; an alternative course of action may be better for some patients). Low Quality of Evidence (low confidence that we know true effects of the intervention). Quality of Evidence lowered due to risk of bias and imprecision. Villanueva DL, Villanueva MC, Llanes EJ. P14 Use of bromocriptine for the treatment of peripartum cardiomyopathy: a meta-analysis of randomized controlled trial. Eur Heart J. 2020;41(suppl 1):S52-S58. doi: 10.1093/ehjci/ehz872.019. Hilfiker-Kleiner D, Haghikia A, Berliner D, et al. Bromocriptine for the treatment of peripartum cardiomyopathy: a multicentre randomized study. Eur Heart J. 2017 Sep 14;38(35):2671-2679. doi: 10.1093/eurheartj/ehx355. PMID: 28934837; PMCID: PMC5837241.

Unknown

Unknown

Suppresses lactation; mother’s values and preferences must be discussed and taken into consideration