Impact of bromocriptine withdrawal timing on pregnancy outcomes in patients with pituitary prolactin-secreting microadenomas: a real-world retrospective study of 188 pregnancies in China

Background This study aims to evaluate the influence of the timing for bromocriptine withdrawal in pregnant women with pituitary prolactin-secreting microadenomas. Methods In this retrospective study,188 pregnant women diagnosed with pituitary prolactin-secreting microadenomas, who delivered between January 2005 and June 2023 were categorized into four groups based on their use and duration of bromocriptine therapy. Their pregnancy and neonatal outcomes were analyzed. Results Among the 188 patients, the incidence of neurological symptoms during pre-pregnancy varied significantly across the groups (P = 0.000), with the highest prevalence in Group A (21.7%) and minimal to no symptoms in other Groups. The live birth rates and miscarriage rates did not show statistically significant differences across the groups (P = 0.508). Premature birth rates were 6.5%, 6.2%, 13.2%, and 0% for Groups A, B, C, and D, respectively. Notably, the incidence of small-for-gestational-age (SGA) infants increased with prolonged bromocriptine use, while large-for-gestational-age (LGA) rates decreased, though these trends were not statistically significant (P = 0.068). Median gestational age differed significantly across groups (P = 0.000), but neonatal weights remained comparable (P = 0.471). Conclusion Discontinuation of bromocriptine after pregnancy confirmation is generally safe for patients with pituitary prolactin-secreting microadenomas. However, for patients with pre-existing neurological or ophthalmological symptoms, or those untreated prior to pregnancy, close monitoring and potential continuation of dopamine agonist therapy are waranted. Bromocriptine exposure throughout pregnancy does not increase the risk of miscarriage, congenital anomalies, or adverse neonatal outcomes. But further prospective studies are needed to elucidate the long-term effects of bromocriptine on fetal development.