The Silent Struggle: Cardiomyopathy, Severe Preeclampsia, and the Invisible Obstacles Moms Face

Imagine being a new mom—your body recovering from the seismic event of childbirth, your heart and blood pressure teetering on the edge of crisis—and the health system you turn to for help missing crucial warning signs. This is the reality for too many women facing severe preeclampsia and peripartum cardiomyopathy (PPCM). These conditions, which can lead to devastating outcomes if not promptly recognized and managed, often slip through the cracks due to systemic blind spots.

For one patient I cared for, the stakes couldn’t have been higher. She arrived at a rural hospital with blood pressure readings over 200 mmHg, shortness of breath, and a history of severe preeclampsia. Despite these red flags, her case highlights the systemic failures that make navigating postpartum complications almost impossible—especially for those without robust support systems. It wasn’t just her medical condition that required urgent attention; it was also her childcare needs, access to diagnostic tools, and coordination of specialized care.

This isn’t a story of individual oversight—it’s a story of a healthcare system that too often fails to see mothers as whole people with complex lives and obligations.

The Dual Threat of Severe Preeclampsia and Peripartum Cardiomyopathy

Severe preeclampsia and PPCM are two of the most dangerous conditions affecting pregnant and postpartum women.

• Severe preeclampsia involves high blood pressure and end-organ damage, often requiring early delivery and intensive monitoring. Left unchecked, it can progress to eclampsia (seizures) or HELLP syndrome, both of which can be life-threatening.

• PPCM, a rare form of heart failure, strikes in the last month of pregnancy or within the first five months postpartum. Its symptoms—shortness of breath, swelling, fatigue—are easy to overlook, especially when chalked up to the normal stress of recovery.

The link between these conditions is undeniable. Studies show preeclampsia increases the risk of PPCM, likely due to shared mechanisms like endothelial dysfunction, inflammation, and antiangiogenic factors such as elevated soluble FMS-like tyrosine kinase-1 (sFlt-1). Yet despite the connection, delays in diagnosis and care are common, with severe consequences.

Addressing the Gaps in Care

Reflecting on my patient’s case, it’s clear that several systemic issues delayed her care:

1. Diagnostic Delays

Despite her shortness of breath—a hallmark symptom of PPCM—diagnostic imaging was delayed, likely due to misplaced concerns about radiation or contrast risks, even though she was no longer pregnant. These hesitations often lead to critical oversight in postpartum care, where conditions like PPCM can quickly escalate if missed.

2. Inappropriate Admission Decisions

Too often, women with complex postpartum conditions are admitted to facilities without the necessary resources. In my patient’s case, had she not been transferred to a higher level of care, she might have missed the cardiology consult and echocardiogram that ultimately confirmed her diagnosis.

3. Coordination of Care

For many moms, managing their health is only one of many responsibilities. In this case, arranging childcare was as critical as arranging a cardiology consult. Yet the healthcare system often overlooks these practical realities, leaving women to shoulder logistical challenges alone.

4. Gaps in Patient Counseling

Understanding the long-term implications of conditions like PPCM and preeclampsia is essential for patients to advocate for their health. However, many women leave the hospital with incomplete information, putting them at risk for poor follow-up and worsening outcomes.

The Diosa Ara Model: Preventing Delays and Providing Holistic Care

At Diosa Ara, we’ve built our clinical model to address the very failures that could have worsened outcomes in this case. The Diosa Ara Model is centered on ensuring timely diagnosis, appropriate escalation of care, and comprehensive patient support during life-threatening health events like severe preeclampsia and PPCM.

1. Real-Time Diagnostics

We equip clinicians with tools and protocols to identify critical conditions like PPCM and severe preeclampsia in real time. By focusing on actionable diagnostics, such as echocardiography and biomarker evaluation, our model prevents delays caused by hesitancy or oversight.

2. Escalation to Higher Levels of Care

The model ensures that patients receive care in the right setting. This includes immediate transfers to facilities with cardiology, maternal-fetal medicine, and intensive care resources when necessary. Our approach prevents inappropriate admissions to under-resourced hospitals that cannot provide comprehensive care.

3. Coordination of Social Support

Diosa Ara recognizes that systemic barriers, such as lack of childcare or transportation, directly impact a patient’s ability to access care. Our model incorporates care coordination that proactively addresses these barriers, ensuring moms can focus on their health without logistical distractions.

4. Patient Education and Empowerment

We prioritize clear, culturally competent counseling to ensure that patients fully understand their diagnosis and its implications. For conditions like PPCM, this includes education about long-term cardiac health, follow-up needs, and potential future risks. Patients leave our care empowered to advocate for their health in a system that too often fails to do so for them.

5. Addressing Inequities in Maternal Health

Black women and low-income patients face disproportionate risks of delayed diagnoses, inadequate care, and poor outcomes. The Diosa Ara model is designed to mitigate these inequities by focusing on equity at every step of care—from diagnostics to discharge planning.

Reimagining Maternal Health

Severe preeclampsia and PPCM exemplify the challenges of postpartum care: conditions that demand timely, coordinated, and patient-centered approaches, but often fall victim to systemic shortcomings. The Diosa Ara Model is our attempt to reimagine what maternal health care can look like, ensuring no woman faces these conditions without the support, resources, and knowledge she needs to survive—and thrive.

We cannot change the fact that pregnancy and the postpartum period come with risks. But we can change how the system responds to those risks, and in doing so, we can save lives.