Prepregnancy Dopamine Agonist Treatment Duration as a Predictor of Postpartum Prolactinoma Remission

Prolactinoma is a major cause of infertility in women of reproductive age. Although pregnancy has been proposed to induce prolactinoma remission, evidence remains inconsistent because of the lack of well-matched control groups. This study evaluated the impact of pregnancy on prolactinoma outcomes and identified predictors of sustained postpartum remission.

We retrospectively analyzed 225 women with prolactinoma treated between 2003 and 2024. Seventy-five patients who became pregnant during dopamine agonist (DA) therapy were matched 1:2 with 150 nonpregnant controls using propensity score matching based on age, baseline prolactin levels, and tumor size. Logistic regression and Kaplan-Meier analyses were performed to assess remission outcomes and identify independent predictors.

Baseline characteristics were well balanced between groups. At the last follow-up (median 110.0 months for the pregnancy group), the final remission rates were comparable between groups (20.0% vs 14.7%, P = .342). Pregnancy was not associated with prolactinoma remission in the overall cohort (P = .576). Among women who became pregnant, a prepregnancy DA treatment duration >48 months was the only significant independent predictor of remission (odds ratio 4.48, 95% confidence interval 1.31-15.36; P = .017). Kaplan-Meier analysis demonstrated significantly higher recurrence-free probability in patients treated for >48 months before conception (P = .020), whereas the 36-month threshold was not significant (P = .103).

Pregnancy itself did not influence the long-term prolactinoma remission. Instead, sustained postpartum remission was associated with at least 48 months of DA therapy before conception, highlighting the importance of adequate treatment duration prior to pregnancy.