Bromocriptine in peripartum cardiomyopathy: A meta-analysis with trial sequential analysis

Area of Science:

• Cardiology
• Pharmacology
• Reproductive Medicine

Background:

• Peripartum cardiomyopathy (PPCM) is a rare but serious condition affecting pregnant or postpartum women.
• Bromocriptine, a dopamine D2 receptor agonist, has been proposed as a disease-modifying therapy for PPCM.
• Long-term outcomes and definitive efficacy of bromocriptine in PPCM remain uncertain.

Purpose of the Study:

• To systematically review and meta-analyze the long-term efficacy and safety of bromocriptine in PPCM.
• To compare bromocriptine plus standard care versus standard care alone using meta-analysis and trial sequential analysis (TSA).

Main Methods:

• Systematic literature search of PubMed, Embase, and Cochrane up to March 2025.
• Inclusion of 12 studies (2 RCTs, 10 observational) with 1765 PPCM patients.
• Meta-analysis of left ventricular (LV) ejection fraction, dimensions, major adverse cardiovascular events (MACE), mortality, and rehospitalization, with TSA for evidence conclusiveness.

Main Results:

• Bromocriptine with standard care significantly improved LV ejection fraction (MD 9.98%) and reduced LV dimensions (end-diastolic: -2.51 cm; end-systolic: -5.61 cm) compared to standard care alone.
• A higher proportion of patients showed improved LV function with bromocriptine (OR 0.35).
• No significant differences were observed in MACE, all-cause mortality, or heart failure rehospitalization between groups.

Conclusions:

• Bromocriptine combined with standard care demonstrates significant improvements in LV function and reverse remodeling in PPCM patients.
• Current evidence suggests promising cardioprotective effects, supported by TSA for LV ejection fraction.
• Larger, adequately powered randomized trials are essential to confirm these findings and establish bromocriptine's role in PPCM management.