האם יש קשר בין גלקטוריאה והפלות טבעיות מוקדמות

הקשר בין היפרפרולקטינמיה והפלות חוזרות מצוי במחלוקת. Bromocriptine Hyperprolactinaemia affects the hypothalamic-pituitary-ovarian system. It is usually characterised by irregular menstruation, infertility and/or galactorrhoea. Its association with recurrent miscarriage is more controversial. Reports offer conflicting results on whether or not hyperprolactinaemia is a feature of recurrent miscarriages.(71,72)A small RCT was done on the use of bromocriptine in women who had isolated hyperprolactinaemia associated with recurrent miscarriages.(73) In this study, women were divided into those with hyperprolactinaemia (basal prolactin level > 10 ng/ml) and those with occult hyperprolactinaemia (basal prolactin level < 10 ng/ml but prolactin levels 20 min after thyrotropin-releasing hormone administration > 86 ng/ml). The study showed a significant decrease in miscarriage rate when women suffering from basal and occult hyperprolactinaemia were given bromocriptine compared to when not given (3/24 [14.3%] vs. 10/24 [47.6%], OR 0.20, 95% CI 0.03–0.99). However, there have been objections to the definition of hyperprolactinaemia in this study and many are not convinced that hyperprolactinaemia is a definite cause of miscarriages, due to both a lack of convincing evidence from studies and no strong biological basis to explain this link.(74) There is therefore no conclusive evidence that the use of bromocriptine in the first trimester is associated with congenital malformations.(69) Recommendations The RCOG in 2003 stated that there is insufficient evidence to assess the effect of hyperprolactinaemia as a risk factor for recurrent miscarriage.(49) Hence, the use of bromocriptine in the management of recurrent miscarriages associated with hyperprolactinaemia cannot be recommended at present.