Article Text

Original research
Systematic review and meta-analysis of prolactin and iron deficiency in peripartum cardiomyopathy
  1. Sinaida Cherubin1,
  2. Taylar Peoples2,
  3. Jessica Gillard3,
  4. Samira Lakhal-Littleton4,
  5. Jennifer J Kurinczuk1 and
  6. Manisha Nair1
  1. 1Nuffield Department of Population Health: National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
  2. 2Mailman School of Public Health, Columbia University, New York, New York, USA
  3. 3Medical Science Division, Oxford University, Oxford, Oxfordshire, UK
  4. 4Department of Physiology, Anatomy and Genetics, Oxford University, Oxford, Oxfordshire, UK
  1. Correspondence to Dr Sinaida Cherubin; sinaida.cherubin{at}


Objectives We 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.

Methods We 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.

Results Two 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).

Conclusions More 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.

  • cardiomyopathies
  • biomarkers
  • pregnancy
  • systematic reviews as topic
  • meta-analysis

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

View Full Text

Statistics from

Supplementary materials


  • Correction notice The contributors statement has been amended to remove MY, and to include MN as a contributor to the conception and design of the work.

  • Contributors SC, SL-L, JJK and MN contributed to the conception and design of the work. SC, TP and JG contributed to the acquisition and analysis of data for the work. SC contributed to the interpretation of data and drafted the manuscript. All authors critically revised the manuscript and gave final approval. All authors agree to be accountable for all aspects of work ensuring integrity and accuracy.

  • Funding This work was supported by the Nuffield Department of Population Health at the University of Oxford which funds SC’s doctoral research. MN is funded by a Medical Research Council (GCRF) Career Development Award (Grant Ref: MR/P022030/1).

  • Disclaimer The funders had no role in the study design or writing of the report. SC had full access to all the information for the paper and had final responsibility for the decision to submit for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study does not involve any human participants; therefore, we did not seek approval from any Ethics Committee or Institutional Board.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.