wileyonlinelibrary.com/journal/anzjog 1 © 2019 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists INTRODUCTION Prolactinomas are a treatable cause of sub-fertility in women. 1-3 Approximately 5% of women with infertility have a prolactinoma, 2 typically presenting with anovulatory cycles. 4,5 Dopamine ago- nist (DA) treatment reportedly restores ovulation in over 90% of women with anovulation, 3,6 although macroprolactinomas (>10 mm diameter) may require transphenoidal surgery or pro- longed DA treatment. 7 The most recent guidelines 6 recommend that DA should be discon- tinued once pregnancy is confrmed. Retrospective studies of short- term DA exposure are reassuring, with no increase in the incidence DOI: 10.1111/ajo.13070 ORIGINAL ARTICLE An observational study of pregnancy and post-partum outcomes in women with prolactinoma treated with dopamine agonists Susannah M. O'Sullivan 1,2 , Maritza T. Farrant 3 , Cara M. Ogilvie 2,3 , Alistair J. Gunn 4,5 and Stella R. Milsom 2,3,6 Aust N Z J Obstet Gynaecol 2019; 1–7 1 Pharmacology, University of Auckland, Auckland, New Zealand 2 Endocrinology, Fertility Associates, Ascot Hospital, Auckland, New Zealand 3 Obstetrics and Gynaecology, National Women's Hospital, Auckland, New Zealand 4 Physiology, University of Auckland, Auckland, New Zealand 5 Paediatrics, University of Auckland, Auckland, New Zealand 6 Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand Correspondence: Dr Susannah M. O'Sullivan, Endocrinology, Fertility Associates, Private Bag 28910, Remuera, Auckland 1541. Email: s.osullivan@auckland.ac.nz Confict of Interest: The authors declare that there is no confict of interest. Received: 9 May 2019; Accepted: 19 August 2019 Background: In women with prolactinoma medical treatment with dopamine ago- nists (DA) can restore fertility. A number of studies have established the safety of DA during pregnancy and the impact of pregnancy and lactation on remission of prolactinoma. However, the total number of reported cases remains modest and further evidence is needed. Aims: To evaluate the safety of DA during pregnancy and remission of prolacti- noma after pregnancy and lactation. Materials and Methods: Retrospective cohort study (2002–2014) of 57 pregnan- cies in 47 women with prolactinoma who received DA. Neonatal and pregnancy complications were recorded. Prolactin levels and treatment data were collected at the time of diagnosis, pre-conception, during pregnancy and lactation, and post- partum (up to 114 months). Results: DA treatment was stopped a median of 4.5 weeks after conception in 49 pregnancies (86%). There were 49 live births (86% of pregnancies) and six miscar- riages. Six pregnancies had an adverse neonatal outcome including two with con- genital malformations. Following 26% of pregnancies women achieved remission after birth or lactation, and 25% of women were in remission at last follow-up. Remission was associated with older maternal age (P = 0.036), a lower prolactin level at diagnosis (P = 0.037), and a smaller adenoma at diagnosis (P = 0.045). Conclusions: Successful pregnancy and lactation is common after DA treatment for prolactinoma. Fetal exposure in the frst four weeks of pregnancy appears to be generally safe. Encouragingly, post-partum and after lactation a quarter of women had a normal prolactin level without medical treatment. KEYWORDS bromocriptine, cabergoline, lactation, pregnancy, prolactinoma