It’s true that where there’s a will, there’s a way. That’s the case with Trista Harper, age 35, of Toms River, New Jersey, who is a wife, mother of three and nurse.

She developed peripartum cardiomyopathy after having her first child, a boy, in 2014. The condition was discovered two days after she underwent a procedure for an umbilical hernia repair following her delivery. This type of hernia is an outward bulge around the belly button due to intense pressure from the baby inside, that can weaken mothers’ abdominal muscles.

“I was vomiting and having extreme shortness of breath, which in turn led me to the emergency department, where I had my first echocardiogram that showed my low ejection fraction,” Trista says.

The term ejection fraction refers to the amount of blood ejected from a chamber of the heart when that muscle squeezes. Trista’s previous condition of peripartum cardiomyopathy is also called postpartum cardiomyopathy, a rare form of heart failure that occurs at the end of a woman’s pregnancy—usually in the last month—or as long as five months following delivery. In this condition, the heart chambers enlarge and the heart muscle weakens, which decreases the blood that the heart pumps with each heartbeat. Peripartum cardiomyopathy is diagnosed in 1 in every 1,000–4,000 deliveries, according to the American Heart Association.

Lack of Risk Factors for Postpartum Cardiomyopathy

Postpartum Cardiomyopathy can be difficult to detect because its symptoms often mimic those of pregnancy. With her first pregnancy, Trista experienced vomiting, difficulty breathing and swollen feet. Later, after delivery, bloodwork showed compromised kidney values.

“Some of these symptoms mask ‘normal’ third trimester symptoms, so postpartum cardiomyopathy can be difficult to diagnose,” Trista says.

It was especially perplexing Trista had none of the common risk factors for peripartum cardiomyopathy:

• High blood pressure
• Preeclampsia
• Gestational hypertension
• Having previous twins
• Being overweight
• Black or African American descent
• Over age 35

After Trista completed treatment for the condition, she had to take medication for the next four years to increase her ejection fraction. Worst of all, she was told she couldn’t have more children due to the risk of a recurrent episode of peripartum cardiomyopathy. But for this determined woman, that was not an option.

Being a Nurse Meant She Knew So Much

Trista is a neonatal intensive care unit nurse (NICU) at Jersey Shore University Medical Center and often talks to families about the importance of heart health. She’s been a nurse for 12 years and worked in the NICU for 11.

“That’s where I always wanted to be, but being in the medical field and knowing so much made things harder for me during this pregnancy experience,” she says.

Maybe it was Trista’s knowledge, combined with her can-do attitude, that prompted her to try to safely get pregnant again. She collaborated with the hospital’s Maternal Fetal Medicine team to carefully undertake her next two pregnancies. That team included maternal and fetal medicine specialist Karen L. Koscica, D.O., along with obstetricians and gynecologists Benjamin Morgan, M.D., and his brother, Steven Morgan, M.D.

“Trista’s ejection fraction, having been low, fully recovered the first few months after her first delivery,” says cardiologist Jesus Almendral, M.D., who specializes in heart failure and transplantation cardiology. He also leads the Advanced Heart Failure Center at Jersey Shore.

Because Trista’s levels normalized so soon, that was a good sign.

Teamwork Sees Her Through Successful Pregnancies

During her second pregnancy in 2020, overseen by one of Dr. Almendral’s colleagues, Trista’s echocardiogram showed that her ejection fraction was normal throughout, which was great news. Dr. Almendral guided Trista through her third pregnancy in 2021, and the two pregnancies resulted in two healthy baby girls.

“When I was closely monitoring Trista, her echocardiogram showed her cardiac function was again completely normal, as was her bloodwork,” Dr. Almendral says. “Research has shown that if someone’s ejection fraction recovers fully after a first pregnancy, the chances of having an uneventful delivery are very good, as was with Trista.”

As she reflects on her journey to have the family she always wanted, Trista says she’s grateful for the experienced medical professionals who ensured both that she achieved her goals—safely. “Everyone worked so well together: my cardiology team, my maternal medicine team and the OB-GYNs,” she says. “I wanted everyone to be on the same page, doing what’s best for me and my unborn children, and that’s exactly what happened.”