Skip to main content
SpringerLink
Log in

Prolactin and Pregnancy

  • Chapter
  • First Online:
Prolactin Disorders

Part of the book series: Contemporary Endocrinology ((COE))

Abstract

Prolactinomas commonly cause reproductive disorders, and treatment usually restores ovulation and fertility. The dopamine agonists are the preferred mode of treatment, with cabergoline generally being preferred to bromocriptine because of its higher therapeutic ratio and better side effect profile. Experience with both drugs shows no increase in spontaneous abortions, preterm deliveries, multiple births, or congenital malformations, compared to what is expected in the normal population, but the experience with bromocriptine is approximately sevenfold greater than with cabergoline. Clinically significant tumor growth may occur in 2.4% of those with microadenomas, 16.4% in those with macroadenomas without prior ablative treatment, and 4.7% of those with macroadenomas with prior ablative treatment. Patients with macroadenomas should have visual fields assessed periodically during gestation. Should symptomatic tumor growth occur, reinstitution of the dopamine agonist is usually successful in shrinking the tumor, but delivery if the pregnancy is sufficiently advanced is also an option, and transsphenoidal debulking is rarely necessary.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Molitch ME. Diagnosis and treatment of pituitary adenomas. JAMA. 2017;317(5):516–24.

    Article  Google Scholar 

  2. Sauder SE, Frager M, Case GD, Kelch RP, Marshall JC. Abnormal patterns of pulsatile luteinizing hormone secretion in women with hyperprolactinemia and amenorrhea: responses to bromocriptine. J Clin Endocrinol Metab. 1984;59(11):941–8.

    Article  CAS  Google Scholar 

  3. Winters SJ, Troen P. Altered pulsatile secretion of luteinizing hormone in hypogonadal men with hyperprolactinaemia. Clin Endocrinol. 1984;21:257–63.

    Article  CAS  Google Scholar 

  4. Brown RSE, Herbison AE, Grattan DR. Prolactin regulation of kisspeptin neurons in the mouse brain and its role in the lactation-induced suppression of kisspeptin expression. J Neuroendocrinol. 2014;26(12):898–908.

    Article  CAS  Google Scholar 

  5. Donato J Jr, Frazão R. Interactions between prolactin and kisspeptin to control reproduction. Arch Endocrinol Metab. 2016;60(6):587–95.

    Article  Google Scholar 

  6. Glass MR, Shaw RW, Butt WR, Edwards RL, London DR. An abnormality of oestrogen feedback in amenorrhoea-galactorrhoea. Br Med J. 1975;3(5978):274–5.

    Article  CAS  Google Scholar 

  7. Feltus FA, Groner B, Melner MH. Stat5-mediated regulation of the human type II 3beta-hydroxysteroid dehydrogenase/delta5-delta4 isomerase gene: activation by prolactin. Mol Endocrinol. 1999;13(7):1084–93.

    CAS  PubMed  Google Scholar 

  8. Ramasharma K, Li CH. Human pituitary and placental hormones control human insulin-like growth factor II secretion in human granulosa cells. Proc Natl Acad Sci U S A. 1987;84:2643–7.

    Article  CAS  Google Scholar 

  9. Demura R, Ono M, Demura H, Shizume K, Oouchi H. Prolactin directly inhibits basal as well as gonadotropin-stimulated secretion of progesterone and 17 beta-estradiol in the human ovary. J Clin Endocrinol Metab. 1982;54(6):1246–50.

    Article  CAS  Google Scholar 

  10. Dorrington JH, Gore-Langton RE. Antigonadal action of prolactin: further studies on the mechanism of inhibition of follicle-stimulating hormone-induced aromatase activity in rat granulosa cell cultures. Endocrinology. 1982;110:1701–7.

    Article  CAS  Google Scholar 

  11. Krasnow JS, Hickey GJ, Richards JS. Regulation of aromatase mRNA and estradiol biosynthesis in rat ovarian granulosa and luteal cells by prolactin. Mol Endocrinol. 1990;4:13–22.

    Article  CAS  Google Scholar 

  12. McNatty KP. Relationship between plasma prolactin and the endocrine microenvironment of the developing human antral follicle. Fertil Steril. 1979;32:433–8.

    Article  CAS  Google Scholar 

  13. Seppälä M, Ranta T, Hirvonen E. Hyperprolactinaemia and luteal insufficiency. Lancet. 1976;1(7953):229–30.

    Article  Google Scholar 

  14. Molitch ME, Reichlin S. Hyperprolactinemic disorders. Dis Mon. 1982;28:1–58.

    Article  CAS  Google Scholar 

  15. Souter I, Baltagi LM, Toth TL, Petrozza JC. Prevalence of hyperprolactinemia and abnormal magnetic resonance imaging findings in a population with infertility. Fertil Steril. 2010;94:1159–62.

    Article  Google Scholar 

  16. Skrabanek P, McDonald D, de Valera E, Lanigan O, Powell D. Plasma prolactin in amenorrhoea, infertility, and other disorders: a retrospective study of 608 patients. Ir J Med Sci. 1980;149(6):236–45.

    Article  CAS  Google Scholar 

  17. Huang KE, Bonfiglio TA, Muechler EK. Transient hyperprolactinemia in infertile women with luteal phase deficiency. Obstet Gynecol. 1991;78:651–5.

    CAS  PubMed  Google Scholar 

  18. Gillam MP, Molitch MP, Lombardi G, Colao A. Advances in the treatment of prolactinomas. Endocr Rev. 2006;27(5):485–534.

    Article  CAS  Google Scholar 

  19. Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronsein MD, et al. Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin Endocrinol. 2006;65(2):265–73.

    Article  Google Scholar 

  20. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montonri VM, Schlechte JA, Wass JAH. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(2):273–88.

    Article  CAS  Google Scholar 

  21. Salvatori R. Surgical treatment of microprolactinomas: pros. Endocrine. 2014;47(3):725–9.

    Article  CAS  Google Scholar 

  22. Ikeda H, Watanabe K, Tominaga T, Yoshimoto T. Transsphenoidal microsurgical results of female patients with prolactinomas. Clin Neurol Neurosurg. 2013;115:1621–3.

    Article  Google Scholar 

  23. Yan Z, Wang Y, Shou X, Su J, Lang L. Effect of transsphenoidal surgery and standard of care on fertility related indicators of patients with prolactinomas during child-bearing period. Int J Clin Exp Med. 2015;8(11):21557–64.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Molitch ME. Endocrinology in pregnancy: management of the pregnant patient with prolactinoma. Eur J Endocrinol. 2015;172(5):R205–13.

    Article  CAS  Google Scholar 

  25. Bigazzi M, Ronga R, Lancranjan I, Ferraro S, Branconi F, Buzzoni P, et al. A pregnancy in an acromegalic woman during bromocriptine treatment: effects on growth hormone and prolactin in the maternal, fetal and amniotic compartments. J Clin Endocrinol Metab. 1979;48(1):9–12.

    Article  CAS  Google Scholar 

  26. Krupp P, Monka C. Bromocriptine in pregnancy: safety aspects. Klin Wochenschr. 1987;65:823–7.

    Article  CAS  Google Scholar 

  27. Krupp P, Monka C, Richter K. The safety aspects of infertility treatments. Program of the Second World Congress of Gynecology and Obstetrics. Rio de Janeiro; 1988. p. 9.

    Google Scholar 

  28. Rastogi A, Bhadada SK, Bhansali A. Pregnancy and tumor outcomes in infertile women with macroprolactinoma on cabergoline therapy. Gynecol Endocrinol. 2017;33(4):270–3.

    Article  CAS  Google Scholar 

  29. Canfield MA, Honelin MA, Yuskiv N, Xing J, Mai CT, Collins JS, et al. National estimates and race/ethnic specific variation of selected birth defects in the United States, 1999–2001. Birth Defects Res A Clin Mol Teratol. 2006;76(11):746–56.

    Article  Google Scholar 

  30. Anon. American Pregnancy Association Statistics. www.americanpregnancy.org/main/statistics.html.

  31. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, Osterman MJ. Births: final data for 2007. Natl Vital Stat Rep. 2010;58(24):1–85.

    PubMed  Google Scholar 

  32. Raymond JP, Goldstein E, Konopka P, Leleu MF, Merceron RE, Loria Y. Follow-up of children born of bromocriptine-treated mothers. Horm Res. 1985;22(3):239–46.

    Article  CAS  Google Scholar 

  33. Canales ES, Garcia IC, Ruiz JE, Zarate A. Bromocriptine as prophylactic therapy in prolactinoma during pregnancy. Fertil Steril. 1981;36:524–6.

    Article  CAS  Google Scholar 

  34. Konopka P, Raymond JP, Merceron RE, Seneze J. Continuous administration of bromocriptine in the prevention of neurological complications in pregnant women with prolactinomas. Am J Obstet Gynecol. 1983;146:935–8.

    Article  CAS  Google Scholar 

  35. Ruiz-Velasco V, Tolis G. Pregnancy in hyperprolactinemic women. Fertil Steril. 1984;41:793–805.

    Article  CAS  Google Scholar 

  36. Ono M, Miki N, Amano K, et al. Individualized high-dose cabergoline therapy for hyperprolactinemic infertility in women with micro- and macroprolactinomas. J Clin Endocrinol Metab. 2010;95(6):2672–9.

    Article  CAS  Google Scholar 

  37. Lebbe M, Hubinont C, Bernard P, Maiter D. Outcome of 100 pregnancies initiated under treatment with cabergoline in hyperprolactinaemic women. Clin Endocrinol. 2010;73:236–42.

    CAS  Google Scholar 

  38. Stalldecker G, Mallea-Gil MS, Guitelman MA, Alfieri A, Bailarino MC, Boero L, et al. Effects of cabergoline on pregnancy and embryo-fetal development: retrospective study on 103 pregnancies and a review of the literature. Pituitary. 2010;13(4):345–50.

    Article  CAS  Google Scholar 

  39. Glezer A, Bronstein MD. Prolactinomas, cabergoline, and pregnancy. Endocrine. 2014;47:64–9.

    Article  CAS  Google Scholar 

  40. Webster J. A comparative review of the tolerability profiles of dopamine agonists in the treatment of hyperprolactinaemia and inhibition of lactation. Drug Saf. 1996;14:228–38.

    Article  CAS  Google Scholar 

  41. Hurault-Delarue C, Montastruc J-L, Beau A-B, Lacroix I, Damase-Michel C. Pregnancy outcome in women exposed to dopamine agonists during pregnancy: a pharmacology study in EFEMERIS database. Arch Gynecol Obstet. 2014;290:263–70.

    Article  CAS  Google Scholar 

  42. Tyson JE, Friesen HG. Factors influencing the secretion of human prolactin and growth hormone in menstrual and gestational women. Am J Obstet Gynecol. 1973;116:377–87.

    Article  CAS  Google Scholar 

  43. Rigg LA, Lein A, Yen SS. Pattern of increase in circulating prolactin levels during human gestation. Am J Obstet Gynecol. 1977;129:454–6.

    Article  CAS  Google Scholar 

  44. Poindexter AN, Buttram VC, Besch PK, Lash B. Circulating prolactin levels. I. Normal females. Int J Fertil. 1977;22:1–5.

    CAS  PubMed  Google Scholar 

  45. Scheithauer BW, Sano T, Kovacs KT, Young WF Jr, Ryan N, Randall RV. The pituitary gland in pregnancy: a clinicopathologic and immunohistochemical study of 69 cases. Mayo Clin Proc. 1990;65(4):461–74.

    Article  CAS  Google Scholar 

  46. Elster AD, Sanders TG, Vines FS, Chen MYM. Size and shape of the pituitary gland during pregnancy and post partum: measurement with MR imaging. Radiology. 1991;181:531–5.

    Article  CAS  Google Scholar 

  47. Dinҫ H, Esen F, Demirci A, Sari A, Resit Gumele H. Pituitary dimensions and volume measurements in pregnancy and post partum. MR assessment. Acta Radiol. 1998;39(1):64–9.

    Google Scholar 

  48. Beshyah SA, Sherif IH, Chentli F, Hamrahian A, Khalil AB, Raef H, et al. Management of prolactinomas: a survey of physicians from the Middle East and North Africa. Pituitary. 2017;20(2):231–40.

    Article  Google Scholar 

  49. Molitch ME. Medical treatment of prolactinomas. Endocrinol Metab Clin N Am. 1999;28(1):143–70.

    Article  CAS  Google Scholar 

  50. Gemzell C, Wang CF. Outcome of pregnancy in women with pituitary adenoma. Fertil Steril. 1979;31:363–72.

    Article  CAS  Google Scholar 

  51. Molitch ME. Pregnancy and the hyperprolactinemic woman. N Engl J Med. 1985;312:1364–70.

    Article  CAS  Google Scholar 

  52. Holmgren U, Bergstrand G, Hagenfeldt K, Werner S. Women with prolactinoma – effect of pregnancy and lactation on serum prolactin and on tumour growth. Acta Endocrinol. 1986;111:452–9.

    Article  CAS  Google Scholar 

  53. Ampudia X, Puig-Domingo M, Schwarzstein D, Corcoy R, Espinos JJ, Calaf-Alsina J, et al. Outcome and long-term effects of pregnancy in women with hyperprolactinemia. Eur J Obstet Gynecol Reprod Biol. 1992;46(2–3):101–7.

    Article  CAS  Google Scholar 

  54. Kupersmith MJ, Rosenberg C, Kleinberg D. Visual loss in pregnant women with pituitary adenomas. Ann Intern Med. 1994;121:473–7.

    Article  CAS  Google Scholar 

  55. Rossi AM, Vilska S, Heinonen PK. Outcome of pregnancies in women with treated or untreated hyperprolactinemia. Eur J Obstet Gynecol Reprod Biol. 1995;63:143–6.

    Article  CAS  Google Scholar 

  56. Badawy SZ, Marziale JC, Rosenbaum AE, Chang JK, Joy SE. The long-term effects of pregnancy and bromocriptine treatment on prolactinomas – the value of radiologic studies. Early Pregnancy. 1997;3(4):306–11.

    CAS  PubMed  Google Scholar 

  57. Mallmann ES, Nagcl A, Spritzer PM. Pregnancy in hyperprolactinemic women. Acta Obstet Gynecol Scand. 2002;81:265–7.

    Article  Google Scholar 

  58. Bronstein MD, Salgado LR, Musolino NR. Medical management of pituiary adenomas: the special case of management of the pregnant woman. Pituitary. 2002;5:99–107.

    Article  CAS  Google Scholar 

  59. Auriemma RS, Perone Y, Di Sarno A, Grasso LF, Guerra E, Gasperi M, et al. Results of a single-center 10-year observational survey study on recurrence of hyperprolactinemia after pregnancy and lactation. J Clin Endocrinol Metab. 2013;98(1):372–9.

    Article  CAS  Google Scholar 

  60. Domingue M-E, Devuyst F, Alexopoulou O, Corvilain B, Maiter D. Outcome of prolactinoma after pregnancy and lactation: a study on 73 patients. Clin Endocrinol. 2014;80(5):642–8.

    Article  Google Scholar 

  61. Piantanida E, Gallo D, Lombardi V, Tanda ML, Lai A, Ghezzi F, et al. Pituitary apoplexy during pregnancy: a rare, but dangerous headache. J Endocrinol Investig. 2014;37(9):789–97.

    Article  CAS  Google Scholar 

  62. Grand’Maison S, Weber F, Bédard M-J, Mahone M, Godbout A. Pituitary apoplexy in pregnancy: a case series and literature review. Obstet Med. 2015;8(4):177–83.

    Article  Google Scholar 

  63. Crosignani PG, Mattei AM, Scarduelli C, Cavioni V, Boracchi P. Is pregnancy the best treatment for hyperprolactinaemia? Hum Reprod. 1989;4(8):910–2.

    Article  CAS  Google Scholar 

  64. Samaan NA, Schultz PN, Leavens TA, Leavens ME, Lee YY. Pregnancy after treatment in patients with prolactinoma: operation versus bromocriptine. Am J Obstet Gynecol. 1986;155(6):1300–5.

    Article  CAS  Google Scholar 

  65. Ikegami H, Aono T, Koizumi K, Fukui H, Tanizawa O. Relationship between the methods of treatment for prolactinomas and the puerperal lactation. Fertil Steril. 1987;47(5):867–9.

    Article  CAS  Google Scholar 

  66. Laws ER Jr, Fode NC, Randall RV, Abboud CF, Coulam CB. Pregnancy following transsphenoidal resection of prolactin-secreting pituitary tumors. J Neurosurg. 1983;58(5):685–8.

    Article  Google Scholar 

  67. McGarrigle HH, Sarris S, Little V, Lawrence D, Radwanska E, Swyer GI. Induction of ovulation with clomiphene and human chorionic gonadotrophin in women with hyperprolactinaemic amenorrhoea. Br J Obstet Gynaecol. 1978;85(9):692–7.

    Article  CAS  Google Scholar 

  68. Radwanska E, McGarrigle HH, Little V, Lawrence D, Sarris S, Swyer GI. Induction of ovulation in women with hyperprolactinemic amenorrhea using clomiphene and human chorionic gonadotropin of bromocriptine. Fertil Steril. 1979;32(2):187–92.

    Article  CAS  Google Scholar 

  69. Divers WA Jr, Yen SS. Prolactin-producing microadenomas in pregnancy. Obstet Gynecol. 1983;62:425–9.

    PubMed  Google Scholar 

  70. Narita O, Kimura T, Suganuma N, Osawa M, Mizutani S, Masahashi T, et al. Relationship between maternal prolactin levels during pregnancy and lactation in women with pituitary adenoma. Nippon Sanka Fujinka Gakkai Zasshi. 1985;37(5):758–62.

    CAS  PubMed  Google Scholar 

  71. Kok RD, de Vries MM, Heerschap A, van den Berg PP. Absence of harmful effects of magnetic resonance exposure at 1.5T in utero during the third trimester of pregnancy: a follow-up study. Magn Res Imaging. 2004;22:851–4.

    Article  Google Scholar 

  72. DeWilde JP, Rivers AW, Price DL. A review of the current use of magnetic resonance imaging in pregnancy and safety implications for the fetus. Prog Biophys Mol Biol. 2005;87:335–53.

    Article  CAS  Google Scholar 

  73. Webb JAW, Thomsen HS, Morcos SK, Members of the Contrast Media Safety Committee of European Society of Urogenital Radiology. The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol. 2005;15:1234–40.

    Article  Google Scholar 

  74. Garcia-Bournissen F, Shrim A, Koren G. Safety of gadolinium during pregnancy. Can Fam Phys. 2006;52:309–11.

    Google Scholar 

  75. American College of Radiology (ACR) Committee on drugs and contrast media. ACT Manual on Contrast Media, Version 10.3, 2017.

    Google Scholar 

  76. Belchetz PE, Carty A, Clearkin LG, Davis JC, Jeffreys RV, Rae PG. Failure of prophylactic surgery to avert massive pituitary expansion in pregnancy. Clin Endocrinol. 1986;25:325–30.

    Article  CAS  Google Scholar 

  77. Brodsky JB, Cohen EN, Brown BW Jr, Wu ML, Whitcher CE. Surgery during pregnancy and fetal outcome. Am J Obstet Gynecol. 1980;138(8):1165–7.

    Article  CAS  Google Scholar 

  78. Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G. Pregnancy outcome following non-obstetric surgical intervention. Am J Surg. 2005;190(3):467–73.

    Article  Google Scholar 

  79. Huang S-Y, Lo P-H, Liu W-M, Cherng Y-G, Yeh C-C, Chen T-L, et al. Outcomes after nonobstetric surgery in pregnant patients: a nationwide study. Mayo Clin Proc. 2016;91(9):1166–72.

    Article  Google Scholar 

  80. Ahlmalki MH, Ur E, Johnson M, Clarke DB, Imran SA. Management of prolactinomas during pregnancy – a survey of four Canadian provinces. Clin Invest Med. 2012;35(2):E96–E104.

    Article  Google Scholar 

  81. Vilar L, Naves LA, Casulari LA, Azevedo MF, Albuquerque JL, Serfaty FM, et al. Management of prolactinomas in Brazil: an electronic survey. Pituitary. 2010;13:199–206.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern Medicine, Chicago, IL, USA

    Mark E. Molitch

Authors
  1. Mark E. Molitch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark E. Molitch .

Editor information

Editors and Affiliations

  1. Neuroendocrine and Pituitary Clinical Center, Massachusetts General Hospital, Boston, MA, USA

    Nicholas A. Tritos

  2. Neuroendocrine and Pituitary Clinical Center, Massachusetts General Hospital, Boston, MA, USA

    Anne Klibanski

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Molitch, M.E. (2019). Prolactin and Pregnancy. In: Tritos, N., Klibanski, A. (eds) Prolactin Disorders. Contemporary Endocrinology. Humana, Cham. https://doi.org/10.1007/978-3-030-11836-5_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-11836-5_9

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-11835-8

  • Online ISBN: 978-3-030-11836-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation