Meta-Analysis

Maternal-related factors associated with development and improvement of peripartum cardiomyopathy and therapeutic outcomes of bromocriptine

I Gusti Bagus Mulia Agung Pradnyaandara1, Ryan Saktika Mulyana2, Jane Carissa Sutedja1, Gusti Ngurah Prana Jagannatha1, I Bagus Satriya Wibawa1, Fanny Deantri1, I Wayan Agus Surya Pradnyana1, Bryan Gervais de Liyis1
1Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia, 2Department of Obstetrics and Gynecology, Prof. dr. I.G.N.G Ngoerah General Hospital, Denpasar, Bali, Indonesia.

HIGHLIGHTS

Younger age, black race, normotension, and multiparity indicate a poorer prognosis for peripartum cardiomyopathy recovery. While bromocriptine therapy reduces adverse events.

ABSTRACT

Objectives: This study aimed to fill the significant knowledge gap regarding peripartum cardiomyopathy (PPCM), a heart failure phenotype linked to pregnancy. The main objectives were to explore the factors influencing the development and progression of PPCM and to assess the outcomes of bromocriptine.
Materials and Methods: Systematic search across PubMed, ScienceDirect, and Cochrane Library identified studies until December 2022. This study includes non-randomized prospective and retrospective studies, as well as relevant randomized controlled trials. Risk factors were compared between the recovered and non-recovered PPCM groups, and bromocriptine therapy outcomes were evaluated against standard heart failure treatment as the primary endpoint.
Results: The analysis included 24 observational studies and 1 randomized controlled trial involving 1,651 PPCM patients; 9 studies evaluating the outcomes of bromocriptine therapy. The most prevalent factors were caesarean delivery (proportion=53%, 95%CI=41%-66%) and anemia (proportion=51%, 95%CI=38%-65%). Non-recovered patients were younger (MD=-1.04 years old, 95%CI=-1.82-(-0.27), p=0.008) and predominantly black (RR=1.82, 95%CI=1.43-2.31, p <0.001). Hypertensive disorders and primiparity were found less among non-recovered patients (RR=0.73, 95%CI=0.60-0.88, p=0.001; RR=0.81, 95%CI=0.66-0.99, p=0.04, respectively). Non-recovered patients also exhibited higher baseline serum creatinine levels, lower LVEF, larger left ventricular end-systolic diameter (LVESD), larger left ventricular end-diastolic diameter (LVEDD), and lower fractional shortening (all P-values<0.05). Furthermore, bromocriptine significantly reduced major adverse cardiac events (MACE), mortality, and increased LVEF (all P-values<0.05).
Conclusion: Younger maternal age, black race, absence of hypertension, and multiparity are associated with poorer prognosis for PPCM recovery. Bromocriptine therapy demonstrates superior benefits in reducing adverse events in PPCM.

Keywords: Bromocriptine; cardiomyopathies; heart failure; pregnancy; risk factors; maternal health