Heart failure (HF) is one of the leading causes of maternal morbidity and mortality in the United States1. Peripartum cardiomyopathy (PPCM) accounts for nearly 70% of all HF in pregnant women.1,2 The European Society of Cardiology defines PPCM as an idiopathic cardiomyopathy that presents as HF with left ventricular (LV) systolic dysfunction in late pregnancy through postpartum period.3 Significant geographical and racial variations have been noted in the incidence of PPCM, with the lowest in Japan (1 in 20,000 live births)4 and the highest in Nigeria (1 in 100 live births).5 The clinical course varies from mild disease with spontaneous recovery to persistent myocardial dysfunction and severe HF, with death occurring in roughly 10% of patients.6,7

While the etiology of PPCM is not entirely understood, multiple hypotheses such as nutritional deficiencies, autoantibodies, genetic mutations, infectious, and vascular processes have been proposed.8,9 Current evidence favors a “double hit” hypothesis involving a vascular insult in addition to genetic predisposition.10,11 The casual role of the cleaved prolactin fragment in the cardiac angiogenic imbalance and development of PPCM has been established in various pre-clinical and clinical models of PPCM.11,12

The current management for PPCM centers around the standard guideline-directed medical therapy (GDMT) for HF with reduced ejection fraction.13 The discovery of prolactin as a potential mediator of PPCM pathophysiology has motivated interest in investigating prolactin inhibition as a potential targeted treatment for PPCM.14 Here, we review the role of prolactin inhibition in the management of PPCM. While a few studies have assessed the efficacy of the prolactin inhibitor, bromocriptine, on the improvement of LV function and mortality, the data are mixed and are limited to small underpowered studies. Moreover, the use of bromocriptine is restricted in the postpartum population due to the increased risk of thromboembolism and disruption of lactation.15,16 In this context, we executed a systematic review and meta-analysis to examine the impact of prolactin inhibitors on LV function and mortality in patients with PPCM.