Maternal and neonatal outcomes after conception during cabergoline therapy for hyperprolactinaemia
SA Booth, S Philip, M Middleton, CM Park, P Abraham & JS Bevan
Background: Since receiving its UK licence in 1994, cabergoline [CAB] has become the dopamine agonist of choice for the management of hyperprolactinaemia in most UK endocrine units. Aim: To review the outcomes for the mother and neonate when CAB is taken during conception and into early gestation. Method: Retrospective review of Aberdeen casenotes from all hyperprolactinaemic women of childbearing age on CAB therapy and those of their live born infants. Results: Twenty women with at least one pregnancy on CAB were identified from our prolactinoma database, six of whom had successfully conceived twice. Conception occurred at a mean age of 29.5 yrs (range 20.9-39.2) after a mean time on CAB of 9 months (range 1-36). CAB dose at conception was 0.25-2.0 mg/wk (median 1.0) and basal PRL levels (mean 2166 mU/l, range 994-6285) had been normalised in all patients. Twenty-four pregnancies were confirmed on CAB therapy which was discontinued after 4-10 weeks gestation (median 6 weeks). Two women conceived within 4 weeks of stopping CAB. These 26 conceptions resulted in 20 live births, (13 males and 7 females); 3 (6.5%) miscarried at 10-13 weeks gestation and 3 (6.5%) went to medical termination for social reasons. Post-partum and post-lactation PRL levels normalised in 4 cases (20%) and were lower than pre-pregnancy levels (where recorded) in 50% (mean 1335 mU/l). Sixteen infants were born by SVD, one by forceps and 3 by emergency LUSCS. All the babies had Apgar scores of 9 by 5 minutes. One was premature (placental abruption) and one was heavy for dates (maternal gestational diabetes), but there were no recorded major birth defects. Conclusion: These data provide further reassurance that CAB exposure in early pregnancy causes no increase in adverse effects for either the mother or the child.