The dopamine agonists (DAs) bromocriptine (BRC) and cabergoline (CAB), are used to restore the hypothalamus-pituitary-gonadal axis in patients with hyperprolactinaemia. BRC is preferred over CAB before and during pregnancy owing to the lack of clinical evidence regarding the effects of the latter on maternal and foetal outcomes. Although recent representative guidelines suggest that both drugs can be used during pregnancy, no study has compared their effects on pregnancy outcomes.
We used data from the national health insurance claims database of the Republic of Korea. The risks of pregnancy-related complications and health problems in the offspring of women exposed to DAs during or within a year before pregnancy were analysed based on the classification of DAs and exposure period.
From 2011-2018, 2,728 and 13,506 women were exposed to CAB and BRC, respectively, during or before pregnancy. Exposure to CAB and BRC during pregnancy increased the risk of gestational hypertension by 67% and 100%, and preterm labour by 64% and 37%, respectively. Exposure to CAB before and during pregnancy increased the risk of congenital malformation by 56% and 49%, respectively; however, BRC exposure did not increase risk regardless of the exposure period. Both CAB and BRC exposure during pregnancy increased the risk of preterm birth, low birth weight, and neonatal intensive care unit (NICU) admission.
Although both DAs increased the risk of adverse pregnancy outcomes, only CAB increased congenital malformation, suggesting the significant evidence that BRC should preferred during pregnancy.