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Randomized Controlled Trial
. 2023 Jun 1;141(6):1115-1123.
doi: 10.1097/AOG.0000000000005190. Epub 2023 May 3.

Cabergoline for Lactation Inhibition After Second-Trimester Abortion or Pregnancy Loss: A Randomized Controlled Trial

Andrea Henkel  1 , Sarah A Johnson, Matthew F Reeves, Erica P Cahill, Paul D Blumenthal, Kate A Shaw
Affiliations
Randomized Controlled Trial

Cabergoline for Lactation Inhibition After Second-Trimester Abortion or Pregnancy Loss: A Randomized Controlled Trial

Andrea Henkel et al. Obstet Gynecol. .

Abstract

Objective: To assess cabergoline's efficacy at decreasing breast symptoms after second-trimester abortion or pregnancy loss.

Methods: This was a double-blinded, block-randomized superiority trial comparing cabergoline 1 mg once to placebo for preventing bothersome breast engorgement after second-trimester uterine evacuation. We enrolled pregnant people at 18-28 weeks of gestation who were English- or Spanish-speaking and without contraindication to the study drug. Participants completed a validated, piloted, electronic survey at baseline and at multiple timepoints through 2 weeks postprocedure to assess breast symptoms, side effects, and bother. Our primary outcome was any breast symptoms (a composite of engorgement, milk leakage, tenderness, and need for pain relief) on day 4; we planned to enroll 80 patients to show a 30% difference in breast symptoms (80% power, α=0.049). A subgroup of participants returned for serum prolactin levels.

Results: After screening 150 patients from April 2021 to June 2022, we enrolled 73 participants. Baseline demographics were balanced between groups: median gestational age was 21 weeks (range 18-26 weeks), 56.2% of participants were nulliparous, 34.2% self-identified as Hispanic, and 37.0% had public insurance. At baseline, reported breast symptoms were similar between groups. Among 69 participants who returned surveys on day 4, significantly fewer participants receiving cabergoline reported any breast symptoms compared with placebo (27.8% vs 97.0%, P<.001) (primary outcome) and fewer reported significant bother (2.8% vs 33.3%, P=.001) (secondary outcome). These differences persisted through day 14. Reported incidence and severity of bother from side effects were similar between groups: most common were constipation, fatigue, and headache. Serum prolactin levels were similar at baseline. On day 4, mean serum prolactin level was 6.5 ng/mL (SD 2.2) for those who received cabergoline and 18.0 ng/mL (SD 5.9) for placebo (P=.049).

Conclusion: Cabergoline is an effective and well-tolerated strategy to prevent breast symptoms after second-trimester abortion or pregnancy loss.

Clinical trial registration: ClinicalTrials.gov, NCT04701333.

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Conflict of interest statement

Financial Disclosure This article discusses off-label use of cabergoline. Matthew F. Reeves reports receiving payments from GemBioPro (distributor of mifepristone, unrelated to cabergoline). The other authors did not report any potential conflicts of interest.

References

    1. Chen FH, Chen SL, Hu WY. Taiwanese women's experiences of lactation suppression after stillbirth. J Obstet Gynecol Neonatal Nurs 2015;44:510–7. doi: 10.1111/1552-6909.12724 - DOI
    1. Hagey JM, Truong T, Deans EI. Breast symptoms after pregnancy loss and abortion: an observational study [abstract]. Obstet Gynecol 2020;135:103S. doi: 10.1097/01.AOG.0000664260.95519.2e - DOI
    1. Sereshti M, Nahidi F, Simbar M, Bakhtiari M, Zayeri F. An exploration of the maternal experiences of breast engorgement and milk leakage after perinatal Loss. Glob J Health Sci 2016;8:234. doi: 10.5539/gjhs.v8n9p234 - DOI
    1. Sriraman NK. The nuts and bolts of breastfeeding: anatomy and physiology of lactation. Curr Probl Pediatr Adolesc Health Care 2017;47:305–10. doi: 10.1016/j.cppeds.2017.10.001 - DOI
    1. Spitz AM, Lee NC, Peterson HB. Treatment for lactation suppression: little progress in one hundred years. Am J Obstet Gynecol 1998;179:1485–90. doi: 10.1016/s0002-9378(98)70013-4 - DOI

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