Cardiomyopathy during pregnancy, though relatively rare, presents a significant concern in the realm of maternal health. Notably, peripartum cardiomyopathy, dilated cardiomyopathy, and hypertrophic cardiomyopathy (HCM) collectively contribute to approximately 11 % of maternal mortality cases.1,2 This elevated risk is closely tied to the profound hemodynamic changes that accompany pregnancy, predisposing individuals to cardiomyopathy and associated symptoms.

The physiological changes during pregnancy include an augmentation in preload secondary to expanded maternal plasma volume in pregnancy women. Simultaneously, decreased afterload ensues due to the additional uterine circulation, resulting in a reduction in systemic vascular resistance, peripheral vasodilation, and a diminished responsiveness to angiotensin and norepinephrine in cardiomyopathies. Furthermore, the third trimester witnesses an escalation in heart rates, culminating in a collective surge of up to 30-50% in cardiac output, thereby heightening the risk of cardiomyopathy progression.3,4

Hypertrophic cardiomyopathy stands as the most prevalent hereditary cardiovascular ailment globally, impacting 1 in 200 to 500 individuals.5,6 It manifests as an autosomal dominant condition, with more than 1400 mutations identified across 11 genes.6 Generally, hypertrophic cardiomyopathy is presumed to be well-tolerated during pregnancy, with fewer complications compared to other cardiomyopathic conditions. Nevertheless, the pre-pregnancy state, pregnancy-related functional capacity, and targeted antenatal care significantly influence outcomes in pregnant women with hypertrophic cardiomyopathy.7

The scarcity of data on hypertrophic cardiomyopathy in pregnant patients makes managing this group challenging. This article aims to enhance understanding of pregnant patients with HCM due to the lack of consensus on their presentation and treatment in this unique population.