The effect of pregnancy and lactation on prolactinoma

Abstract

Prolactinoma predominantly occurred in young women of reproductive age. But there are limited data about the effect of pregnancy and lactation on prolactinoma progression. We evaluated the safety of dopamine agonists including bromocriptine and cabergoline and pregnancy outcome in prolactinoma patients. Patients diagnosed with prolactinoma who experienced pregnancies were included. Sellar MRI and serum prolactin levels were performed before and after pregnancy and lactation. Total 46 patients with 62 pregnancies were included. Among 62 pregnancies, spontaneous pregnancies analyzed 61 (98.3 %) and only one pregnancy was made by in vitro fertilization. Live births were in 51 (82.3 %), while spontaneous abortions occurred in 11 (17.7%). Twenty-one were treated with cabergoline at the time of conception, whereas twenty-eight with bromocriptine. We divided patients into two groups by their changes of adenoma size after delivery; increased (n = 22) or decreased (n = 15). Patients with bigger adenoma size before pregnancy showed significantly increased after childbirth. However, the enlarged adenoma did not cause any clinical problems. Of all, breast- feeding was performed in 38 pregnancies. Mean duration of lactation was 4.9 +/- 4.4 months. Among those 38, 16 patients had done MRI follow-up after the lactation. There were decreased adenoma sizes in 9 patients, no changes in 5 patients, while increased only in two patients. In conclusion, breast-feeding is not contraindicated in patients with prolactinoma, especially those who had smaller adenoma.