An observational study of pregnancy and post‐partum outcomes in women with prolactinoma treated with dopamine agonists

Abstract

Background:In women with prolactinoma medical treatment with dopamine agonists (DA) can restore fertility. A number of studies have established the safety of DA during pregnancy and the impact of pregnancy and lactation on remission of prolactinoma. However, the total number of reported cases remains modest and further evidence is needed. Aims:To evaluate the safety of DA during pregnancy and remission of prolactinoma after pregnancy and lactation. Materials and Methods: Retrospective cohort study (2002-2014) of 57 pregnancies in 47 women with prolactinoma who received DA. Neonatal and pregnancy complications were recorded. Prolactin levels and treatment data were collected at the time of diagnosis, pre-conception, during pregnancy and lactation, and postpartum (up to 114 months).Results: DA treatment was stopped a median of 4.5 weeks after conception in 49 pregnancies (86%). There were 49 live births (86% of pregnancies) and six miscarriages. Six pregnancies had an adverse neonatal outcome including two with congenital malformations. Following 26% of pregnancies women achieved remission after birth or lactation, and 25% of women were in remission at last follow-up.Remission was associated with older maternal age (P = 0.036), a lower prolactin level at diagnosis (P = 0.037), and a smaller adenoma at diagnosis (P = 0.045). Conclusions:Successful pregnancy and lactation is common after DA treatment for prolactinoma. Fetal exposure in the first four weeks of pregnancy appears to be generally safe. Encouragingly, post-partum and after lactation a quarter of women had a normal prolactin level without medical treatment. K E Y W O R D Sbromocriptine, cabergoline, lactation, pregnancy, prolactinoma

Outcomes of Patients with Macroprolactinoma Desiring Pregnancy: Follow-Up to 23 Years from a Single Center

“…Recently, postpartum remission rates have been reported to be between 9-36 % in macroprolactinomas [13,14,16,30]. In our study, early postpartum remission was 9.5 %, which was compatible with the above studies and it was increased to 33.3 % in the longterm follow-up.…”

“…In the literature, most of the studies evaluated micro and macroadenomas together. In these studies, advanced maternal age (35-45 years), smaller initial adenoma size, lower PRL levels at diagnosis and postpartum period were reported as the predictors of remission at last follow-up visit [3,6,13,14,16]. Domingue et al [13] reported that normalization of pituitary MRI after pregnancy were independently associated with remission in a retrospective two-center study, which included only 19 macroadenomas.…”

“…On the other hand, it is difficult to give clear information about the prognosis of macroprolactinomas due to the lack of available treatment guidelines of these rare tumors [2]. In most previous studies, these rare tumors have been evaluated all together with hyperprolactinemia and microprolactinomas [1,3,6,[13][14][15][16]. Therefore, the aim of this study is to evaluate the effects of treatment with DAs on tumors before and during pregnancy, the safety of DAs on the fetus, and the prognosis after pregnancy while performing long-term follow-up (up to 23 years) of pregnant women diagnosed with macroprolactinoma.…”

Comparison between Rectal Bromocriptine and Oral Cabergoline in Treatment of Hyperprolactinemia

“…S.M.O'Sullivan [14] found that Treatment with a DA reestablishes ovulation in over 90% of ladies with prolactinoma and anovulatory fruitlessness and their examination affirms that DA use during the initial five weeks of pregnancy is protected and not related with an expansion in the quantity of unsuccessful labors, intrinsic contortions or other unfavorable neonatal and pregnancy results past populace typical reaches. R.Krysiak [10] found that Both bromocriptine and cabergoline, the two most ordinarily endorsed dopaminergic specialists, share numerous attributes and unfavorable impacts.…”

“…Besides, these courses are helpful for patients who might be not able or reluctant to swallow prescription and it is a viable course in the treatment of patients with heaving scenes. For fundamental impacts, the mucous films of the rectum license the ingestion of numerous dissolvable medications [14].…”