Safety of Cabergoline for Prolactinoma in Pregnancy: A Systematic Review and Meta-Analysis

Abstract

Introduction: Prolactinoma is commonly treated with cabergoline, a dopamine D2 agonist. The present systematic review and meta-analysis aimed to assess the safety of cabergoline during pregnancy by examining outcomes of fetal loss, congenital malformations, preterm delivery, low birth weight, and change of tumour size post-gestation. Method: We conducted a systematic review as per PRISMA guidelines, focusing on pregnant patients with prolactinoma. Using the PICO model, we analyzed pregnancy outcomes in women continued cabergoline during gestation versus discontinuation at pregnancy diagnosis. Our methodologies included data extraction, study selection, and outcome analysis. Results: A total of 12 studies mentioning 1387 pregnancies with prolactinoma were included. Fetal loss occurred in 16.1% of cases, while congenital malformations were observed in 4.7%. The live birth rates among cabergoline users during gestation were lower compared to non-users [RR 0.81 (0.67–0.98, 95% CI); p = 0.03]. The congenital malformations [0.99 (95% CI: 0.93–1.07); p = 0.88], preterm birth [RR: 1.00 (95% CI: 0.93–1.07); p = 0.97] and low birth weight [RR: 1.02 (95% CI: 0.90–1.16); p = 0.71] showed no differences between the two groups. Conclusion: Cabergoline, when continued during pregnancy, is associated with a lower chance of live birth compared to discontinuation of pregnancy at diagnosis of pregnancy in women with prolactinoma. However, there was no increased risk of incident congenital malformation, preterm birth or low birth weight. The analysis suggests careful consideration of cabergoline use in pregnant women with prolactinoma.