Approximately 80% of women with prolactinoma can become pregnant after treatment with bromocriptine. As a general principle, the fetus should be exposed to the drug as little as possible. Therefore contraception should be used as soon as 2-3 periods occur in order to allow the menstrual cycle to establish so that the woman knows when to stop.
If the prolactinoma is <10 mm in diameter prior to pregnancy, the drug may be discontinued as the likelihood of tumor enlargement is minimal. If the pre-pregnancy prolactinoma is ≥10 mm in diameter, treatment with bromocriptine is indicated. A multicenter study with 2437 female participants investigating the safety of bromocriptine use during part or all of pregnancy and observing fetuses through 9 years of age in children whose mothers took bromocriptine during pregnancy has confirmed the safety of bromocriptine use during pregnancy. Bromocriptine reduced maternal blood prolactin levels to the fetus but did not increase spontaneous abortions, congenital malformations, or fictitious pregnancies. However, the use of bromocriptine during pregnancy is still recommended for the control of prolactinoma, while bromocriptine is suspended for the first 4 weeks after conception. Some patients must be examined every 2 months during pregnancy, and routine visualization is required if there is a history or symptoms of a large prolactinoma, usually at least once every 3 months. Finally, if visual field loss is increased with bromocriptine, early delivery or surgery should be considered.