Author + information
- Received August 22, 2018
- Revision received January 10, 2019
- Accepted January 11, 2019
- Published online June 24, 2019.
- Agnes Koczo, MDa,
- Amy Marino, MDa,
- Arun Jeyabalan, MDa,
- Uri Elkayam, MDb,
- Leslie T. Cooper, MDc,
- James Fett, MD, MPHa,
- Joan Briller, MDd,
- Eileen Hsich, MDe,
- Lori Blauwet, MDf,
- Charles McTiernan, PhDa,
- Penelope A. Morel, MDa,
- Karen Hanley-Yanez, BSa,
- Dennis M. McNamara, MD, MSa,∗ (, )
- for the IPAC Investigators
- aUniversity of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- bUniversity of Southern California, Los Angeles, California
- cMayo Clinic, Jacksonville, Florida
- dUniversity of Illinois, Chicago, Illinois
- eCleveland Clinic, Cleveland, Ohio
- fMayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Dennis M. McNamara, University of Pittsburgh Medical Center, Scaife Hall, Room S-566, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213.
• The impact of breastfeeding on prolactin, cellular immune activation, and myocardial recovery was analyzed in 100 women with peripartum cardiomyopathy
• Cardiac function was assessed by echocardiography at presentation and at serial intervals over the first year postpartum
• The levels of circulating prolactin were assessed by ELISA, and cellular immunophenotyping by flow cytometry, and compared between breastfeeding and nonbreastfeeding women
• Prolactin levels were higher in breastfeeding women and correlated with significant increases in CD8+ T cells
• Despite significantly higher prolactin levels and increased CD8+ cells, myocardial recovery was similar in breastfeeding and nonbreastfeeding women
The etiology of peripartum cardiomyopathy remains unknown. One hypothesis is that an increase in the 16-kDa form of prolactin is pathogenic and suggests that breastfeeding may worsen peripartum cardiomyopathy by increasing prolactin, while bromocriptine, which blocks prolactin release, may be therapeutic. An autoimmune etiology has also been proposed. The authors investigated the impact of breastfeeding on cellular immunity and myocardial recovery for women with peripartum cardiomyopathy in the IPAC (Investigations in Pregnancy Associated Cardiomyopathy) study. Women who breastfed had elevated prolactin, and prolactin levels correlated with elevations in CD8+ T cells. However, despite elevated prolactin and cytotoxic T cell subsets, myocardial recovery was not impaired in breastfeeding women.
This investigation was supported by the National Heart, Lung, and Blood Institute through contract HL102429. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and U.S. Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Basic to Translational Science author instructions page.
- Received August 22, 2018.
- Revision received January 10, 2019.
- Accepted January 11, 2019.
- 2019 The Authors