OBJECTIVE: Dissecting glucose metabolism during and after pregnancy in patients with prolactinomas.
METHODS: 52 patients treated with cabergoline (CAB) were evaluated before conception, during pregnancy and up to 10 years after delivery. During pregnancy, CAB was discontinued, while it was restarted in 57.7 % of patients after delivery, due to recurrent hyperprolactinemia (RH). Hormonal (serum PRL) and metabolic (HbA1c, fasting glucose/FG, glucose tolerance) parameters were assessed.
RESULTS: During pregnancy, PRL gradually increased, while FG remained stable. An inverse correlation between PRL and FG was found in the first (p=0.032) and third (p=0.048) trimester. PRL percent increase across pregnancy was inversely correlated with third trimester FG. Serum PRL before conception emerged as predictive biomarker of third trimester FG (τ=2.603; p=0.048). Elderly patients with lower HbA1c at first trimester and lower FG at 3 years postpartum, delivered infants with reduced birth weight. Breastfeeding up to 6 months correlated with lower FG at 4 and 10 years postpartum. A positive correlation between BMI and FG at 10 years after delivery (p=0.03) was observed, particularly in overweight/obese patients requiring higher CAB doses. Patients with RH who had to restart CAB showed shorter breastfeeding duration and higher FG at 2 years postpartum.
CONCLUSIONS: Low PRL levels before pregnancy may be detrimental to FG during pregnancy. CAB duration and dose may influence long-term glucose tolerance, besides family history and BMI. Pre-conceptional metabolic management should be recommended to reduce the risk of gestational and type 2 diabetes mellitus.
目的:剖析泌乳素腺瘤患者妊娠期间和妊娠后的糖代谢。
方法:52例接受卡麦角林(CAB)治疗的患者在受孕前进行评估,在怀孕期间和分娩后长达10年。在怀孕期间,CAB停产了,虽然57.7%的患者在分娩后重新启动,由于复发性高泌乳素血症(RH)。激素(血清PRL)和代谢(HbA1c,空腹血糖/FG,糖耐量)参数进行了评估。
结果:在怀孕期间,PRL逐渐增加,而FG保持稳定。在前三个月(p=0.032)和第三个三个月(p=0.048)中发现PRL和FG之间的负相关。整个怀孕期间PRL百分比的增加与妊娠晚期FG呈负相关。受孕前血清PRL作为妊娠晚期FG的预测生物标志物(τ=2.603;p=0.048)。妊娠早期HbA1c较低,产后3年FG较低的老年患者,出生体重减轻的婴儿。母乳喂养长达6个月与产后4年和10年FG降低相关。在分娩后10年观察到BMI和FG之间的正相关(p=0.03),特别是在需要更高CAB剂量的超重/肥胖患者中。必须重新开始CAB的RH患者在产后2年表现出更短的母乳喂养持续时间和更高的FG。
结论:怀孕前低PRL水平可能对怀孕期间的FG有害。CAB持续时间和剂量可能会影响长期葡萄糖耐量,除了家族史和BMI。应建议进行孕前代谢管理,以降低妊娠和2型糖尿病的风险。