72
Treatment
Table 30. HF Management Strategies Across the
Pregnancy Continuum
Preconception
Pharmacological
strategies
Review of all current medications.
For women planning pregnancy imminently, modification of
HF pharmacotherapy including. discontinuation of any ACEi,
ARB, ARNi, MRA, or SGLT2i or ivabradine medications;
within a construct of multidisciplinary shared decision-making,
continuation of a beta blocker (most commonly metoprolol),
hydralazine, and nitrates; adjustment of diuretic dosing to
minimize the risk of placental hypoperfusion.
Ideally, repeat echocardiography approximately 3 mo aer
preconception HF medication adjustments to ensure stability
of myocardial structure and function before conception.
Multidisciplinary
care beyond the
cardiolog y team
Consultation with genetics, g ynecolog y, and maternal-fetal
medicine teams, as appropriate to the outcome of shared
decision-making.
* An initial open-label pilot RCT in South Africa suggested addition of bromocriptine to
GDMT was associated with greater LVEF improvement and a lower rate of the composite
endpoint at 6 mo.
(cont'd)
