Breastfeeding a baby with mother on Bromocripine
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《美国医学杂志》
Department of Pediatrics, University College of Medical Sciences & Guru Tegh Bahadur Hospital, Delhi, India
Abstract
Prolactinomas, the most common pituitary adenomas, are important causes of infertility. Bromocriptine remains the treatment of choice for managing hyperprolactinemia in most of these cases. Breastfeeding in mothers receiving bromocriptine is often doubtful and matter of concern for most people. Here we report a case, where by timely intervention and skilled counseling, exclusive breastfeeding could be established in a mother receiving bromocriptine for the treatment of hyperprolactinemia.
Keywords: Breastfeeding; Bromocriptine; Hyperprolactinemia.
Hyperprolactinemia is an important cause of infertility, and bromocriptine is the most common agent used to treat this condition. Most often, the cause of chronic hyperprolactinemia is a pituitary [macro (>1 cm) or micro (<1 cm)] adenoma. Treatment with bromocriptine may need to continue beyond successful pregnancy in cases of pituitary adenomas, as its discontinuation may cause recurrence or increase in size of the tumor. Breastfeeding following delivery in these cases is often doubtful and a matter of concern for most people.
Here, we report a case, where, by timely intervention and proper counseling, exclusive breast feeding could be established in a baby whose mother was on bromocriptine therapy for prolactinoma from last 6 years.
Case Report
A 34-year-old lady delivered a female baby weighing 3.2 kg in the G.T.B. hospital following cesarean section. She was diagnosed to be having hyperplolactinemia around 6 years back, when she was investigated for primary infertility (serum prolactin 800 ng/ml). Her contrast enhanced CT scan revealed a pituitary macroadenoma. She was started on bromocriptine therapy, following which she conceived after 2 years and delivered her first baby in some private hospital As per opinion by doctors there, she was told that she would not be able to breastfeed the baby and started on top feeding since birth. This child suffered from recurrent episodes of diarrhea and dysentery in infancy and was underweight (Wt-9 kg) at the age of 4 years.
This time also she was very much apprehensive about feeding her baby because of her previous experience, worry about the effect of drugs and was not confident. In view of the possibility of successful breastfeeding with mother receiving bromocriptine, she was counseled for this feeding option.[1],[2] She was motivated but had fear of failure and her baby getting starved. Intensive counseling sessions involving trained counselors (DS and MMAF) were organized for her as per the standard modules.[3] She was told about the possibility of breastfeeding while continuing the drugs. She was demonstrated about proper positioning and attachment of the baby. Her sister-in-law who was also lactating was also involved to build up her confidence. This lady also offered to breastfeed the baby for alleviating her fear of baby getting starved. She offered her breast to the baby three times in the first 2 days after birth, when the mother felt that baby is crying because of hunger. However, most of the feeding was done by the mother herself.
With these efforts, she started breastfeeding exclusively from the third day of life. Her confidence further boosted after observing that the baby was calm and composed after breastfeeding. The child regained birth weight on the tenth day and was discharged. The baby continued to gain weight adequately on follow-up to 5 months of age when his weight was 6 kg.
Discussion
Dopamine agonists have significantly increased the number of pregnancies in women with micro and macro prolactinomas by restoring ovulation in great majority of them.[4] The treatment with these drugs may have to be continued sometimes even after the pregnancy is established because of the possible risk of tumor enlargement following cessation of therapy.[5] While the risk of tumor increase is low in patients with prolactin secreting microadenoma, in prolactin secreting macroadenoma patients the possibility of tumor growth is enhanced and influenced by previous treatment.[5] Pregnant patients with microadenoma, therefore, must be reassured and medical therapy suspended, with successive clinical follow-up. In the case of pregnant macroadenoma subjects, bromocriptine therapy continuation is recommended with a careful follow-up.[5] Lactation apparently has no effect on growth of the pituitary tumor.[4],[6],[7],[8]
Bromocriptine remains the drug of choice for treatment of prolactinomas.[9] Though there is a paucity of published indexed literature on the effect of bromocriptine on fetus, few studies from China and Japan have demonstrated no effect.[10] In a study from China involving 30 pregnant females, no adverse effect of bromocriptine on fetus could be demonstrated.[1]
Prolactin secretion needed for lactation is primarily under inhibitory control mediated by dopamine. Bromocriptine, a dopamine agonist, has been used by many for suppressing lactation. Understandably, successful breastfeeding is a concern when mother is receiving bromocriptine therapy. However, prolactin levels in maternal blood during pregnancy might not influence the amount of lactation in puerperium; successful breastfeeding is possible with mothers taking bromocriptine for pituitary adenoma.[2] A study by Zhang et al showed that 75% of such mothers, who were on bromocriptine therapy during pregnancy, could breast feed successfully with little help.[1]
The benefits of breast feeding have been well- documented; it reduces morbidity from many illnesses and is considered the ideal nutrition for the newborn infant.[11] In the difficult situations when there are concerns about lactation, skilled counseling definitely has a role.[11],[12] Timely counseling by doctors and trained staff by providing necessary information and support definitely helps in building confidence and establishing breastfeeding successfully.
Conclusion
Exclusive breastfeeding can be successfully established in babies whose mothers are receiving bromocriptine for treatment of hyperprolactinemia during pregnancy and lactation. There is a definite role of skilled breastfeeding counseling in these difficult cases.
References
1. Zhang Z, Cheng W. Management of pituitary adenoma in pregnancy. Zhonghua Fu Chan Ke Za Zhe 1996; 3: 537-539.
2. Narita O, Kimura T, Suganuma N, Osawa M, Mizutania S, Masahashi T et al. Relationship between maternal prolactin levels during pregnancy and lactation in women with pituitary adenoma. Nippon Sanka Gakkai Zasshai 1985; 37: 758-765.
3. Breastfeeding Counseling and Complementary Feeding: A Training Course. Breastfeeding Promotion Network of India, 2001, New Delhi. Document BPNI/TRG/BCCF/2001.
4. Zarate A, Canales ES, Alger M, Forsbach G. The effect of pregnancy and lactation on pituitary secreting tumors. Acta Endocrinol 1979; 42: 407.
5. Chiodini I, Liuzzi A. Prolactin secreting pituitary adenomas in pregnancy. J Endocrinol Invest 2003; 26 : 96-99.
6. Molitch ME. Medical management of prolactin secreting pituitary adenomas. Pituitary 2002; 5: 55-65.
7. Andersen AN, Tabor A, Hertz JB, Schioler V. Abnormal prolactin levels and pituitary gonadal axis in the puerperium. Obstet Gynecol 1981; 57: 725-729.
8. Ventz M, Puhlmann B, Knappe G, Gerl H, Lehmann R, Ronde W. Pregnancy in hyperprolactinemic patients. Zentralbl Gynakol 1996; 118: 610-615.
9. Nimikos P, Buchfelder M, Fahlburch R. Current management of prolactinomas. J Neurooncol 2001; 54: 139-150.
10. Webster J. A comparative review of the tolerablility profile of dopamine agonists in the treatment of prolactinemia and inhibition of lactation . Drug Saf 1996; 14: 228-238.
11. Melnikow J, Bedinghaus JM. Mangement of common breastfeeding problems. J Fam Pract 1994; 39: 56-64.
12. Rajan L. The contribution of professional support, information and consistent correct advise to successful breastfeeding. Midwifery 1993; 9: 197-209.(Verma Sanjay, Shah Dheera)
Abstract
Prolactinomas, the most common pituitary adenomas, are important causes of infertility. Bromocriptine remains the treatment of choice for managing hyperprolactinemia in most of these cases. Breastfeeding in mothers receiving bromocriptine is often doubtful and matter of concern for most people. Here we report a case, where by timely intervention and skilled counseling, exclusive breastfeeding could be established in a mother receiving bromocriptine for the treatment of hyperprolactinemia.
Keywords: Breastfeeding; Bromocriptine; Hyperprolactinemia.
Hyperprolactinemia is an important cause of infertility, and bromocriptine is the most common agent used to treat this condition. Most often, the cause of chronic hyperprolactinemia is a pituitary [macro (>1 cm) or micro (<1 cm)] adenoma. Treatment with bromocriptine may need to continue beyond successful pregnancy in cases of pituitary adenomas, as its discontinuation may cause recurrence or increase in size of the tumor. Breastfeeding following delivery in these cases is often doubtful and a matter of concern for most people.
Here, we report a case, where, by timely intervention and proper counseling, exclusive breast feeding could be established in a baby whose mother was on bromocriptine therapy for prolactinoma from last 6 years.
Case Report
A 34-year-old lady delivered a female baby weighing 3.2 kg in the G.T.B. hospital following cesarean section. She was diagnosed to be having hyperplolactinemia around 6 years back, when she was investigated for primary infertility (serum prolactin 800 ng/ml). Her contrast enhanced CT scan revealed a pituitary macroadenoma. She was started on bromocriptine therapy, following which she conceived after 2 years and delivered her first baby in some private hospital As per opinion by doctors there, she was told that she would not be able to breastfeed the baby and started on top feeding since birth. This child suffered from recurrent episodes of diarrhea and dysentery in infancy and was underweight (Wt-9 kg) at the age of 4 years.
This time also she was very much apprehensive about feeding her baby because of her previous experience, worry about the effect of drugs and was not confident. In view of the possibility of successful breastfeeding with mother receiving bromocriptine, she was counseled for this feeding option.[1],[2] She was motivated but had fear of failure and her baby getting starved. Intensive counseling sessions involving trained counselors (DS and MMAF) were organized for her as per the standard modules.[3] She was told about the possibility of breastfeeding while continuing the drugs. She was demonstrated about proper positioning and attachment of the baby. Her sister-in-law who was also lactating was also involved to build up her confidence. This lady also offered to breastfeed the baby for alleviating her fear of baby getting starved. She offered her breast to the baby three times in the first 2 days after birth, when the mother felt that baby is crying because of hunger. However, most of the feeding was done by the mother herself.
With these efforts, she started breastfeeding exclusively from the third day of life. Her confidence further boosted after observing that the baby was calm and composed after breastfeeding. The child regained birth weight on the tenth day and was discharged. The baby continued to gain weight adequately on follow-up to 5 months of age when his weight was 6 kg.
Discussion
Dopamine agonists have significantly increased the number of pregnancies in women with micro and macro prolactinomas by restoring ovulation in great majority of them.[4] The treatment with these drugs may have to be continued sometimes even after the pregnancy is established because of the possible risk of tumor enlargement following cessation of therapy.[5] While the risk of tumor increase is low in patients with prolactin secreting microadenoma, in prolactin secreting macroadenoma patients the possibility of tumor growth is enhanced and influenced by previous treatment.[5] Pregnant patients with microadenoma, therefore, must be reassured and medical therapy suspended, with successive clinical follow-up. In the case of pregnant macroadenoma subjects, bromocriptine therapy continuation is recommended with a careful follow-up.[5] Lactation apparently has no effect on growth of the pituitary tumor.[4],[6],[7],[8]
Bromocriptine remains the drug of choice for treatment of prolactinomas.[9] Though there is a paucity of published indexed literature on the effect of bromocriptine on fetus, few studies from China and Japan have demonstrated no effect.[10] In a study from China involving 30 pregnant females, no adverse effect of bromocriptine on fetus could be demonstrated.[1]
Prolactin secretion needed for lactation is primarily under inhibitory control mediated by dopamine. Bromocriptine, a dopamine agonist, has been used by many for suppressing lactation. Understandably, successful breastfeeding is a concern when mother is receiving bromocriptine therapy. However, prolactin levels in maternal blood during pregnancy might not influence the amount of lactation in puerperium; successful breastfeeding is possible with mothers taking bromocriptine for pituitary adenoma.[2] A study by Zhang et al showed that 75% of such mothers, who were on bromocriptine therapy during pregnancy, could breast feed successfully with little help.[1]
The benefits of breast feeding have been well- documented; it reduces morbidity from many illnesses and is considered the ideal nutrition for the newborn infant.[11] In the difficult situations when there are concerns about lactation, skilled counseling definitely has a role.[11],[12] Timely counseling by doctors and trained staff by providing necessary information and support definitely helps in building confidence and establishing breastfeeding successfully.
Conclusion
Exclusive breastfeeding can be successfully established in babies whose mothers are receiving bromocriptine for treatment of hyperprolactinemia during pregnancy and lactation. There is a definite role of skilled breastfeeding counseling in these difficult cases.
References
1. Zhang Z, Cheng W. Management of pituitary adenoma in pregnancy. Zhonghua Fu Chan Ke Za Zhe 1996; 3: 537-539.
2. Narita O, Kimura T, Suganuma N, Osawa M, Mizutania S, Masahashi T et al. Relationship between maternal prolactin levels during pregnancy and lactation in women with pituitary adenoma. Nippon Sanka Gakkai Zasshai 1985; 37: 758-765.
3. Breastfeeding Counseling and Complementary Feeding: A Training Course. Breastfeeding Promotion Network of India, 2001, New Delhi. Document BPNI/TRG/BCCF/2001.
4. Zarate A, Canales ES, Alger M, Forsbach G. The effect of pregnancy and lactation on pituitary secreting tumors. Acta Endocrinol 1979; 42: 407.
5. Chiodini I, Liuzzi A. Prolactin secreting pituitary adenomas in pregnancy. J Endocrinol Invest 2003; 26 : 96-99.
6. Molitch ME. Medical management of prolactin secreting pituitary adenomas. Pituitary 2002; 5: 55-65.
7. Andersen AN, Tabor A, Hertz JB, Schioler V. Abnormal prolactin levels and pituitary gonadal axis in the puerperium. Obstet Gynecol 1981; 57: 725-729.
8. Ventz M, Puhlmann B, Knappe G, Gerl H, Lehmann R, Ronde W. Pregnancy in hyperprolactinemic patients. Zentralbl Gynakol 1996; 118: 610-615.
9. Nimikos P, Buchfelder M, Fahlburch R. Current management of prolactinomas. J Neurooncol 2001; 54: 139-150.
10. Webster J. A comparative review of the tolerablility profile of dopamine agonists in the treatment of prolactinemia and inhibition of lactation . Drug Saf 1996; 14: 228-238.
11. Melnikow J, Bedinghaus JM. Mangement of common breastfeeding problems. J Fam Pract 1994; 39: 56-64.
12. Rajan L. The contribution of professional support, information and consistent correct advise to successful breastfeeding. Midwifery 1993; 9: 197-209.(Verma Sanjay, Shah Dheera)