**5.4 Maladaptation to stress of pregnancy**

The hyperdynamic circulation during pregnancy causes remodeling and transient hypertrophy of the left ventricle. The exaggerated reduction in left ventricular systolic function with stress of gestational hypertension may contribute to heart failure in PPCM patients. In pregnancy 40–50% increase in blood volume and cardiac output occurs which results in transient LV hypertrophy. The hemodynamic stress of gestational hypertension, may contribute to the development of PPCM and heart failure, with an angiogenic imbalance may better explain the association between preeclampsia and PPCM [17].
