DOI: 10.1055/s-0036-1592295 - volume 38 - Agosto 2016
James D. Fett
It is premature to make a recommendation for treatment of peripartum cardiomyopathy (PPCM) with prolactin inhibition (bromocriptine or cabergoline) as in the one-case report of Melo et al.1
There are now multiple reports of trials for PPCM subjects in the use prolactin inhibition treatment compared with non-use of this modality that show no statistically significant benefit in recovery outcomes at 6 and 12 months postpartum.2,3
Furthermore, there is still potential risk to the use of these agents in the peripartum setting, with multiple reports of cardiovascular catastrophes, including myocardial infarction, coronary artery spasm, and stroke.4
What is still needed is a carefully controlled investigation of use of bromocriptine or cabergoline vs non-use as adjunct or non-adjunct to conventional therapy for heart failurewith systolic dysfunction.
Melo et al emphasize the need for effective treatment of PPCM "[...]particularly in developing countries." We have shown the devastating effect on otherwise healthy neonates whose mothers died fromPPCM, with high mortality rates for these children as a consequence of losing the source of breast milk when a mother dies.5 An effective program to provide alternative nutrition must accompany any treatment programthat deprives newborns of amother's breast milk. This is an issue of concern particularly in developing countries.