From the Guidelines
Checking prolactin levels at routine obstetrics appointments is not necessary for most pregnant women, as prolactin is naturally elevated during pregnancy and this elevation is expected and normal. Prolactin testing is typically only indicated in specific situations, such as when a woman has symptoms suggesting a pituitary disorder (like vision changes, severe headaches), a history of pituitary tumors, unexplained galactorrhea (milk discharge) before pregnancy, or infertility that might be related to hyperprolactinemia 1. For most healthy pregnant women with no concerning symptoms or medical history, routine prolactin monitoring provides little clinical value since levels naturally rise throughout pregnancy, peaking at delivery, and remain elevated during breastfeeding.
Some key points to consider when evaluating the need for prolactin testing include:
- Hyperprolactinemia can be caused by various factors, including pituitary tumors, hypothyroidism, and certain medications 1
- The physiological increase in prolactin during pregnancy is essential for preparing the mammary glands for lactation after delivery and is regulated by increasing estrogen levels produced by the placenta
- If prolactin testing is needed for specific medical reasons, it should be interpreted carefully within the context of pregnancy, as normal pregnancy values differ significantly from non-pregnant reference ranges
In general, the American College of Obstetricians and Gynecologists (ACOG) recommends a thorough evaluation, including medical history, physical examination, and selected laboratory and imaging tests, to determine the cause of abnormal uterine bleeding associated with ovulatory dysfunction, which may include measurement of prolactin levels 1. However, this does not necessarily apply to routine obstetrics appointments for healthy pregnant women without concerning symptoms or medical history. In summary, routine prolactin testing is not recommended for most pregnant women, but may be indicated in specific situations where there are symptoms or medical history suggestive of a pituitary disorder or other conditions that may affect prolactin levels.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... Dosage may be increased by 0. 25 mg twice weekly up to a dosage of 1 mg twice a week according to the patient's serum prolactin level. The FDA drug label does not answer the question.
From the Research
Importance of Prolactin Check at OB Appointment
- Prolactin levels are checked at an obstetrics (OB) appointment to identify any potential issues related to hyperprolactinemia, a condition characterized by elevated prolactin levels in the blood 2, 3.
- Hyperprolactinemia can be caused by various factors, including pituitary adenomas, medications, hypothyroidism, renal failure, and idiopathic hyperprolactinemia 2, 3, 4.
- In pregnant or lactating women, high prolactin levels can occur as a physiological condition, but pathological hyperprolactinemia can lead to gonadal dysfunction, infertility, and other complications 3.
Potential Consequences of Hyperprolactinemia
- Untreated hyperprolactinemia can result in symptoms such as galactorrhea, amenorrhea, and oligomenorrhea, as well as increased risk of osteoporosis and other long-term complications 3, 4.
- In some cases, hyperprolactinemia can be caused by ectopic production of prolactin, such as from an ovarian teratoma 5.
- Macroprolactinemia, a condition characterized by large protein complexes of prolactin, can also cause hyperprolactinemia and may be misdiagnosed as idiopathic hyperprolactinemia 6.
Management and Treatment of Hyperprolactinemia
- Pharmacological intervention with dopamine agonists, such as bromocriptine or cabergoline, is often the first line of treatment for hyperprolactinemia 2, 3, 4.
- Surgery or radiation therapy may be necessary in some cases, such as when a pituitary adenoma is present or when medical therapy is ineffective 2, 3.
- Identification of macroprolactinemia is important to prevent unnecessary examinations and treatments in patients with idiopathic hyperprolactinemia 6.