Results

Demographic and obstetric characteristics

A total of 50 patients with PPCM and LVEF below 45% were included. Group A (n=25) received bromocriptine with standard therapy, and Group B (n=25) received standard therapy alone. Age distribution was similar between groups (p = 0.976), and parity did not differ significantly (p = 0.13). Gestational age at presentation was significantly lower in Group A than in Group B (33.76 ± 7.84 vs 37.72 ± 1.57 weeks; p = 0.017), with a mean difference of -3.96 weeks (95% CI, -7.25 to -0.67). Four patients in Group A presented before 25 weeks of gestation, whereas none in Group B did. BMI was also lower in Group A (22.49 ± 3.10 vs 24.01 ± 1.75 kg/m2; p = 0.037), with a mean difference of -1.526 kg/m2 (95% CI, -2.97 to -0.08). These baseline differences were clinically important, were considered potential confounders, and are summarized in Table 1.

Parameter | Category | Group A: bromocriptine + standard therapy (n=25) | Group B: standard therapy (n=25) | P value
Age (years) | <25 | 10 (40%) | 9 (36%) | 0.976
25-30 | 10 (40%) | 10 (40%)
>30 | 5 (20%) | 6 (24%)
Mean ± SD | 26.36 ± 4.38 | 26.40 ± 4.82
Parity | Primigravida | 5 (20%) | 11 (44%) | 0.13
Multigravida | 20 (80%) | 14 (56%)
Gestational age at presentation (weeks) | <25 | 4 (16%) | 0 (0%) | 0.017*
25-35 | 6 (24%) | 2 (8%)
>35 | 15 (60%) | 23 (92%)
Mean ± SD | 33.76 ± 7.84 | 37.72 ± 1.57
Body mass index (kg/m2) | <20 | 4 (16%) | 0 (0%) | 0.037*
20.01-25.00 | 15 (60%) | 17 (68%)
>25 | 6 (24%) | 8 (32%)
Mean ± SD | 22.49 ± 3.10 | 24.01 ± 1.75

Clinical profile and medical history

Comorbidity distribution differed between the two groups (p = 0.033). Group A included patients with acute parenchymal renal disease, anemia, chronic hypertension, chronic nephritis, gestational diabetes on insulin, non-specific presentation, non-specific presentation with twins, hypothyroidism, and twin pregnancy. Group B included a higher recorded prevalence of hypothyroidism. Presenting complaints, past history, and family history were not statistically different between groups. The clinical profile and medical history variables are summarized in Table 2.

Parameter | Category | Group A: bromocriptine + standard therapy (n=25), n (%) | Group B: standard therapy (n=25), n (%) | P value
Comorbidity | Acute parenchymal renal disease | 1 (4%) | 0 (0%) | 0.033*
Anemia | 2 (8%) | 0 (0%)
Chronic hypertension | 1 (4%) | 0 (0%)
Chronic nephritis | 1 (4%) | 0 (0%)
Gestational diabetes on insulin | 3 (12%) | 0 (0%)
Hypothyroidism | 0 (0%) | 8 (32%)
Non-specific presentation | 4 (16%) | 4 (16%)
NSP/twins with hypothyroidism | 1 (4%) | 0 (0%)
Twins | 1 (4%) | 0 (0%)
Nil | 11 (44%) | 13 (52%)
Presenting complaints | Breathlessness | 8 (32%) | 2 (8%) | 0.063
Breathlessness with anemia | 1 (4%) | 0 (0%)
Palpitations | 1 (4%) | 0 (0%)
Nil | 15 (60%) | 23 (92%)
Past history | Hypothyroidism | 3 (12%) | 0 (0%) | 0.114
Peripartum cardiomyopathy | 1 (4%) | 0 (0%)
Nil | 21 (84%) | 25 (100%)
Family history | Myocardial infarction in father | 0 (0%) | 2 (8%) | 0.078
Myocardial infarction in mother | 0 (0%) | 2 (8%)
Stroke in father | 0 (0%) | 2 (8%)
Nil | 25 (100%) | 19 (76%)

Baseline laboratory and biochemical parameters

Peripheral smear findings were comparable between groups (p = 0.19). Urine albumin distribution differed significantly (p = 0.006), with higher grades of albuminuria more frequent in Group B. Urine sugar, sodium, potassium, fasting blood sugar, HbA1c, troponin, and creatine phosphokinase-myocardial band (CPK-MB) did not differ significantly. Lipid profile abnormalities were more frequent in Group A (p = 0.002), whereas elevated liver transaminases were recorded only in Group B (p = 0.003). Mean thyroid-stimulating hormone (TSH) was lower in Group A than in Group B (2.34 ± 0.71 vs 3.71 ± 1.07 uU/mL; p < 0.001), and the difference in thyroid-related variables was considered another potential confounder. Baseline laboratory and biochemical parameters are summarized in Table 3.

Parameter | Category | Group A: bromocriptine + standard therapy (n=25) | Group B: standard therapy (n=25) | P value
Peripheral smear (CHG/PS) | Dimorphic anemia | 1 (4%) | 5 (20%) | 0.190
Hypochromic microcytic anemia | 1 (4%) | 0 (0%)
Microcytic anemia | 1 (4%) | 0 (0%)
Normal | 22 (88%) | 20 (80%)
Urine albumin | + | 4 (16%) | 2 (8%) | 0.006*
++ | 0 (0%) | 10 (40%)
+++ | 1 (4%) | 0 (0%)
Loaded | 2 (8%) | 0 (0%)
Nil | 18 (72%) | 13 (52%)
Urine sugar | + | 0 (0%) | 0 (0%) | 1.000
++ | 1 (4%) | 0 (0%)
+++ | 0 (0%) | 0 (0%)
Loaded | 0 (0%) | 0 (0%)
Nil | 24 (96%) | 25 (100%)
Serum sodium (mEq/L) | Mean ± SD | 137.8 ± 3.488 | 139.2 ± 4.359 | 0.216
Serum potassium (mEq/L) | Mean ± SD | 3.812 ± 0.639 | 3.768 ± 0.256 | 0.751
Fasting blood sugar (mg/dL) | Mean ± SD | 92.12 ± 13.286 | 91.56 ± 11.644 | 0.875
HbA1c (%) | <5 | 12 (48%) | 8 (32%) | 0.304
>5 | 13 (52%) | 17 (68%)
Mean ± SD | 5.368 ± 0.726 | 5.596 ± 0.822
Lipid profile | Hypercholesterolemia | 3 (12%) | 0 (0%) | 0.002*
Hypertriglyceridemia | 7 (28%) | 0 (0%)
Normal | 15 (60%) | 25 (100%)
Liver function test | Elevated SGOT/SGPT | 0 (0%) | 9 (36%) | 0.003*
Normal | 25 (100%) | 16 (64%)
TSH (uU/mL) | Mean ± SD | 2.342 ± 0.707 | 3.712 ± 1.067 | <0.001*
Troponin (ng/mL) | Mean ± SD | 0.0264 ± 0.0196 | 0.0268 ± 0.0221 | 0.946
CPK-MB (IU/mL) | Mean ± SD | 16.24 ± 7.401 | 15.8 ± 2.291 | 0.778

Cardiac assessment

Electrocardiographic findings differed between groups (p = 0.033), with sinus tachycardia recorded in Group A only, whereas ventricular premature complexes were present in both groups. Baseline LVEF distribution and mean LVEF did not differ significantly (38.36 ± 2.40% in Group A vs 39.00 ± 1.19% in Group B; p = 0.238). Chest radiographic findings differed significantly (p = 0.004), with cardiomegaly and increased vascular markings recorded only in Group A.

At discharge, mean LVEF was 47.52 ± 2.52% in Group A and 46.56 ± 2.82% in Group B (p = 0.210), with a mean between-group difference of 0.96 percentage points (95% CI, -0.56 to 2.48). The discharge comparison, therefore, did not rule out a clinically relevant difference. At one month, mean LVEF was 57.00 ± 1.71% in Group A and 49.84 ± 1.38% in Group B (p < 0.001), with a mean between-group difference of 7.16 percentage points (95% CI, 6.28 to 8.04). Cardiac assessment findings, including serial LVEF results, are summarized in Table 4.

Parameter | Category | Group A: bromocriptine + standard therapy (n=25) | Group B: standard therapy (n=25) | P value
Electrocardiogram | Sinus tachycardia | 6 (24%) | 0 (0%) | 0.033*
Ventricular premature complexes | 5 (20%) | 6 (24%)
Within normal limits | 14 (56%) | 19 (76%)
Echocardiography (baseline LVEF%) | <35% | 3 (12%) | 0 (0%) | 0.238
>35% | 22 (88%) | 25 (100%)
Mean ± SD | 38.36 ± 2.396 | 39.00 ± 1.190
Chest X-ray | Cardiomegaly | 5 (20%) | 0 (0%) | 0.004*
Increased vascular markings | 4 (16%) | 0 (0%)
Normal | 16 (64%) | 25 (100%)
LVEF at discharge (%) | <45% | 4 (16%) | 11 (44%) | 0.21
>45% | 21 (84%) | 14 (56%)
Mean ± SD | 47.52 ± 2.519 | 46.56 ± 2.815
LVEF after one month (%) | <45% | 0 (0%) | 0 (0%) | <0.001*
>45% | 25 (100%) | 25 (100%)
Mean ± SD | 57.00 ± 1.708 | 49.84 ± 1.375

Obstetric and neonatal outcomes

Gestational age at delivery differed significantly between groups (p = 0.031), with preterm delivery more frequent in Group A. Mode of delivery was not significantly different (p = 0.324). Birth weight was lower in Group A (2.43 ± 1.13 vs 3.07 ± 0.41 kg; p = 0.01), with a mean difference of -0.64 kg (95% CI, -1.13 to -0.15). Apgar score distributions at one minute and five minutes differed between the groups (p < 0.001 for both). Nevertheless, because the Group B distributions were uniform and the groups differed in gestational age at delivery and birth weight, these findings were interpreted cautiously and were not attributed to bromocriptine. Neonatal intensive care unit admission was similar between groups (44% in Group A vs 32% in Group B; p = 0.56). Obstetric and neonatal outcomes are summarized in Table 5.

Parameter | Category | Group A: bromocriptine + standard therapy (n=25) | Group B: standard therapy (n=25) | P value
Gestational age at delivery (weeks) | <25 | 4 (16%) | 0 (0%) | 0.031*
25-35 | 3 (12%) | 2 (8%)
>35 | 18 (72%) | 23 (92%)
Mean ± SD | 34.44 ± 7.52 | 37.96 ± 1.594
Mode of delivery | Induced abortion | 1 (4%) | 0 (0%) | 0.324
Normal vaginal delivery | 14 (56%) | 14 (56%)
Lower segment cesarean section | 8 (32%) | 11 (44%)
Spontaneous expulsion | 2 (8%) | 0 (0%)
Birth weight (kg) | <2.50 | 9 (36%) | 2 (8%) | 0.01*
2.50-3.00 | 9 (36%) | 11 (44%)
>3.00 | 7 (28%) | 12 (48%)
Mean ± SD | 2.43 ± 1.126 | 3.072 ± 0.411
Apgar score (one minute) | 0 | 4 (16%) | 0 (0%) | <0.001*
5 | 2 (8%) | 25 (100%)
6 | 3 (12%) | 0 (0%)
7 | 4 (16%) | 0 (0%)
8 | 12 (48%) | 0 (0%)
Apgar score (five minutes) | 0 | 4 (16%) | 0 (0%) | <0.001*
7 | 3 (12%) | 0 (0%)
8 | 2 (8%) | 0 (0%)
9 | 13 (52%) | 0 (0%)
10 | 3 (12%) | 25 (100%)
NICU admission | Yes | 11 (44%) | 8 (32%) | 0.56
No | 14 (56%) | 17 (68%)