Systematic review and meta-analysis of prolactin and iron deficiency in peripartum cardiomyopathy

Abstract

ObjectivesWe conducted a systematic review and meta-analysis of studies that compared levels of molecular biomarkers in women with peripartum cardiomyopathy (PPCM) to those in healthy pregnant and postpartum women to: (1) assess the evidence for prolactin (PRL) metabolism in PPCM, (2) ascertain the evidence for biomarkers of iron deficiency in PPCM, (3) identify other biomarkers associated with PPCM.MethodsWe searched Medline, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and the Global Health Library from inception without language restriction for studies that compared biomarkers levels in PPCM cases to healthy controls. Pooled standardised mean difference (SMD) was generated using a random effects model for the difference in levels of biomarkers.ResultsTwo studies assessed the association of PRL with PPCM, and reported that PPCM cases have higher levels of total PRL. No studies investigated iron metabolism in PPCM. Other biomarkers associated with PPCM included serum levels of natriuretic peptides (SMD=3.77, 95% CI 0.71 to 6.82), albumin (SMD=-0.67, 95% CI -1.01 to -0.32), C-reactive protein (SMD=1.67, 95% CI 0.22 to 3.12), selenium (SMD=-0.73, 95% CI -1.58 to 0.12), cardiac troponins (SMD=1.06, 95% CI 0.33 to 1.80), creatinine (SMD=0.51, 95% CI 0.33 to 0.69), white bloodcells (SMD=0.44, 95 % CI 0.07 to 0.82), haemoglobin (SMD=-0.45, 95% CI -0.64 to-0.26).ConclusionsMore robust molecular studies are needed to explore the association between prolactin and PPCM in human subjects and to determine the extent to which iron deficiency (with or without anaemia) contributes to the risk of PPCM.

Outcomes of Newly Diagnosed Patients of Peripartum Cardiomyopathy at Liaquat University Hospital, Hyderabad, Sindh, Pakistan

“…In a study conducted by Dhesi S [9] & Lindley KJ [10] and their colleagues confirms underlying mechanism and the findings of our study. While some of the international studies had also observed non-traditional risk factors of CHF in patients with PPCM like increased levels of uric acid, mother of male infant, and higher levels of prolactin [11,12].…”

Cardiogenic shock in pregnancy

“…For example, in variable concentrations, prolactin can regulate the contraction and relaxation of vascular smooth muscle, thus modulating vascular tone. In animal models, excess oxidative stress is postulated to mediate the upregulation of prolactin cleavage factors, leading to an increase in the concentration of a prolactin isoform with anti‐angiogenic and apoptotic properties 28,29 . This isoform has been associated with dysfunctional cardiometabolism, destruction of the cardiac microvasculature and impaired cardiac muscle contraction 30,31 .…”

Pathophysiology and risk factors of peripartum cardiomyopathy

“…Several studies have determined whether specific biomarkers were associated with PPCM, which were summarized by Cherubin et al 95 . The authors evaluated 117 biomarkers from 31 case-control studies.…”

“…See Table 1 for an overview of biomarkers. A quantitative meta-analysis suggested that patients with PPCM had higher levels of natriuretic peptides, troponin, CRP, and white blood cell counts, but reduced levels of albumin and selenium compared with healthy controls 95 . Note that these biomarkers mostly reflect the presence of cardiomyopathy and appear to be unspecific for PPCM.…”