Lactation Safety in Peripartum Cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening form of heart failure that occurs toward the end of pregnancy or in the months following delivery. It is characterized by left ventricular systolic dysfunction in women without preexisting structural heart disease. Despite increasing recognition, the pathophysiology of PPCM remains incompletely understood. Accumulating experimental and clinical evidence supports a central role for hormonal dysregulation in disease development, particularly involving prolactin (PRL). During late pregnancy and the postpartum period, heightened oxidative stress promotes cleavage of full-length PRL into a 16-kDa fragment with potent antiangiogenic, proinflammatory, and proapoptotic properties. While total circulating PRL levels are elevated in PPCM, it is the generation of the 16-kDa PRL fragment, rather than absolute PRL concentration, that appears to be most strongly linked to disease severity and progression. The recognition of this mechanism has provided a framework for targeted therapeutic strategies. As many women choose to breastfeed, there are concerns about the safety of breastfeeding in PPCM. This review summarizes the experimental and clinical evidence related to elevated PRL levels, particularly the cleaved 16-kDa PRL fragment's contribution to disease development, with emphasis on lactation safety in PPCM.