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Reproductive and Perinatal Outcomes in Women with Congenital Adrenal Hyperplasia: A Population-based Cohort Study
Angelica Lindén Hirschberg1,2, Sebastian Gidlöf1,3,4, Henrik Falhammar5,6
1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Context:
Reduced fertility has been reported for women with congenital adrenal hyperplasia (CAH), especially for those with the salt-losing form. However, data are sparse on reproductive and perinatal outcomes in these women.
Objective:
To investigate reproductive and perinatal outcomes in women with CAH.
Design And Setting:
Population-based and nationwide study using the National CAH Register, the Total Population Register, and the Medical Birth Register of Sweden.
Participants:
A total of 272 women with CAH due to 21-hydroxylase deficiency and 27 200 controls matched by sex, age, and place of birth. The median age was 31 years.
Main Outcome Measures:
The proportion of CAH women that have given birth, and reproductive and perinatal outcomes.
Results:
Of the 272 women with CAH, 69 gave birth to at least 1 child (25.4%), which was a lower frequency than for the controls (45.8%) (P < .001). Furthermore, women with CAH had fewer children than controls and were slightly older at birth of their first child. More women with CAH were diagnosed with gestational diabetes than controls, 4.9% versus 1.4% (P < .05), and more women with CAH were delivered through cesarean section, 51.4% versus 12.3% (P < .05). There was no difference in Apgar score or frequency of small-for-gestational age between children born to mothers with CAH and controls.
Conclusions:
This is, to our knowledge, the largest cohort designed to investigate reproductive and perinatal outcomes in women with CAH. We found the birth rate to be lower in women with CAH; gestational diabetes and cesarean section were more common, but perinatal outcomes were comparable with controls.
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