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Pregnancy Outcomes in Women With Primary Adrenal Insufficiency: Data From a Multicentre Cohort Study
Author(s) -
Cauldwell Matthew,
Steer Philip J.,
Ahsan Masato,
Ali Amanda,
Ashiq Shabana,
Ashworth Rebecca,
Basha Deena,
Chong Hsu,
Corbett Gillian A.,
Dunne Fidelma,
Hill Amanda,
GajewskaKnapik Katarzyna,
Jakes Adam,
McLaren David,
Kinsella Therese,
Lee Tara,
Levy Miles,
MacKiliop Lucy,
McAuliffe Fionnuala M.,
Mohan Aarthi,
Mumby Clare,
Nana Melanie,
Napier Catherine,
Neuberger Francesca,
Newman Christine,
Oosterhouse Tabitha,
Shard Amelia,
Shehata Hassan,
Stocker Linden,
Tomlinson Jeremy W.,
Beck Adele,
Vaidya Bijay,
Wiles Kate,
Williamson Catherine,
Zollner Julia,
Ward Emma,
Turner Helen E.
Publication year - 2025
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.18143
Subject(s) - medicine , pregnancy , obstetrics , caesarean section , adrenal crisis , retrospective cohort study , adrenal insufficiency , congenital adrenal hyperplasia , cohort , live birth , pediatrics , genetics , biology
ABSTRACT Objective To determine characteristics and pregnancy outcomes in women with primary adrenal insufficiency (PAI). Design Retrospective multicentre cohort study. Setting Twenty‐three maternity units in the UK and Ireland. Sample Seventy‐nine women with PAI who had 101 pregnancies. Method Retrospective chart analysis. Main Outcome Measures Adrenal crisis, pregnancy outcomes. Results We obtained data on 101 pregnancies in 79 women with PAI. Most (51, 64.1%) had autoimmune disease, 8 (10.3%) had prior adrenal infarction/surgery/haemorrhage, 2 (2.6%) had congenital adrenal hyperplasia, and 18 (21.3%) were unclassified. 19 (24%) women experienced a crisis during pregnancy (18.8% of pregnancies). One woman died postpartum. Although all women had recorded endocrinology input during pregnancy, steroid emergency cards were only reportedly carried in 40 (39.6%) pregnancies and 9/19 (47.4%) of those with an adrenal crisis in pregnancy. Compared with the pre‐pregnancy dose, only 41% of women received an increased hydrocortisone dose in pregnancy. The caesarean section rate was higher than the UK average: 62/97 (63.9%). The preterm birth rate was 21.2% (21/99) and 12.8% (12/94) of neonates had a birthweight < 10th centile. Conclusion Whilst the obstetric outcome of pregnancy with PAI is generally favourable, there are high rates of caesarean birth and prematurity. A high number of women experienced adrenal crisis and further exploration is warranted. Recommendations regarding third trimester increases in hydrocortisone need consideration and potentially strengthening, in light of further evidence. Pregnant women with adrenal insufficiency should carry an NHS steroid warning card; this should be reinforced both by endocrine and obstetric teams because of the increased risk of life‐threatening adrenal crisis.