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. 2019 Jun 24;4(3):291-300.
doi: 10.1016/j.jacbts.2019.01.010. eCollection 2019 Jun.

Breastfeeding, Cellular Immune Activation, and Myocardial Recovery in Peripartum Cardiomyopathy

Agnes Koczo  1 , Amy Marino  1 , Arun Jeyabalan  1 , Uri Elkayam  2 , Leslie T Cooper  3 , James Fett  1 , Joan Briller  4 , Eileen Hsich  5 , Lori Blauwet  6 , Charles McTiernan  1 , Penelope A Morel  1 , Karen Hanley-Yanez  1 , Dennis M McNamara  1 ; IPAC Investigators
Collaborators, Affiliations

Breastfeeding, Cellular Immune Activation, and Myocardial Recovery in Peripartum Cardiomyopathy

Agnes Koczo et al. JACC Basic Transl Sci. .

Abstract

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.

Keywords: BF, breastfeeding; LVEF, left ventricular ejection fraction; NBF, nonbreastfeeding; PPCM, peripartum cardiomyopathy; breastfeeding; immune activation; peripartum cardiomyopathy.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Percentage CD3+CD8+ T Cells at Entry and 2 and 6 Months for the Breastfeeding and Nonbreastfeeding Cohorts CD3+CD8+ cytotoxic T cells in breastfeeding women were significantly higher at entry (p = 0.003) and remained significant at 2 (p = 0.02) and 6 (p = 0.01) months postpartum.
Figure 2
Figure 2
Correlation of the Percentage CD3+CD8+ T Cells With Prolactin Levels in the Overall and Breastfeeding Peripartum Cardiomyopathy Cohorts (A) In the overall peripartum cardiomyopathy cohort, higher serum levels of prolactin at entry were associated with a higher percentage of CD3+CD8+ cells (n = 98; p = 0.01). (B) In the smaller breastfeeding subset, higher serum prolactin levels remained significantly associated with a higher percentage of CD3+CD8+ cells (n = 13; p = 0.04).
Figure 3
Figure 3
Left Ventricular Ejection Fraction at Entry and 6 and 12 Months for the Breastfeeding and Nonbreastfeeding Cohorts Mean left ventricular ejection fraction (LVEF) at entry displayed a trend toward a higher mean LVEF in the breastfeeding subset (p = 0.06), which was significant at 6 months (p = 0.07) but not 12 months (p = 0.16) postpartum.
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