Management of Peripartum Cardiomyopathy With and Without Bromocriptine: A Comparative Study

Introduction: Peripartum cardiomyopathy is an uncommon but potentially severe cause of pregnancy-associated systolic heart failure. Bromocriptine has been proposed as an adjunctive therapy because it suppresses prolactin release, but its interpretation depends on the background heart failure regimen, dose, anticoagulation practice, and patient selection. This study compared short-term left ventricular ejection fraction (LVEF) recovery in patients managed with standard therapy with or without low-dose bromocriptine. Methods: This prospective comparative observational study was conducted at a tertiary care center in South India from October 2020 to October 2021. A total of 50 patients with peripartum cardiomyopathy and LVEF below 45% were analyzed according to treatment received. Group A (n=25) received bromocriptine 2.5 mg once daily for one week in addition to standard pregnancy/postpartum-compatible heart failure therapy, and Group B (n=25) received standard therapy alone. Treatment allocation was not randomized, and no allocation concealment was used. Echocardiography was used to assess LVEF at baseline, discharge, and one month. Continuous variables were compared with the independent samples Student's t-test, and categorical variables were compared with the chi-square test or Fisher's exact test. Results: Baseline LVEF did not differ significantly between Group A and Group B (38.36 ± 2.40% vs 39.00 ± 1.19%; p = 0.238). Important baseline differences were present, including gestational age at presentation (33.76 ± 7.84 vs 37.72 ± 1.57 weeks; p = 0.017), body mass index (22.49 ± 3.10 vs 24.01 ± 1.75 kg/m2; p = 0.037), comorbidity distribution (p = 0.033), electrocardiographic findings (p = 0.033), and chest radiographic findings (p = 0.004). At discharge, mean LVEF was 47.52 ± 2.52% in Group A and 46.56 ± 2.82% in Group B (p = 0.210). At one month, mean LVEF was higher in Group A than in Group B (57.00 ± 1.71% vs 49.84 ± 1.38%; p < 0.001). Gestational age at delivery (p = 0.031) and birth weight (p = 0.010) differed between the groups; neonatal intensive care unit admission did not (p = 0.560). Recorded Apgar score distributions were retained as abstracted, but the uniform control-group values require cautious interpretation. Conclusion: Both groups showed improvement in left ventricular function. Low-dose one-week bromocriptine was associated with greater one-month LVEF in this cohort, but the non-randomized design, baseline imbalances, limited documentation of background therapy and anticoagulation, and short follow-up preclude causal claims. The findings should be interpreted as hypothesis-generating and require confirmation in larger protocolized studies with adjustment for confounding and longer follow-up.