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Published on: April 25, 2016
Pregnancy Outcomes in Women With Primary Adrenal Insufficiency: Data From a Multicentre Cohort Study
Matthew Cauldwell1, Philip J Steer2, Masato Ahsan3
1Department of Obstetrics, Maternal Medicine Service, St George's Hospital, London, UK.
Summary
Pregnancy in women with primary adrenal insufficiency (PAI) generally has favorable outcomes, but carries risks of adrenal crisis and requires careful management of hydrocortisone dosage. Enhanced patient education on steroid emergency cards is crucial.
Area of Science:
- Endocrinology
- Obstetrics
- Reproductive Medicine
Background:
- Primary adrenal insufficiency (PAI) is a rare but serious endocrine disorder.
- Pregnancy in women with PAI presents unique challenges for both maternal and fetal health.
- Understanding pregnancy outcomes and management strategies is vital for improving care.
Purpose of the Study:
- To characterize women with PAI during pregnancy.
- To evaluate pregnancy outcomes in women with PAI.
- To identify areas for improved management and patient safety.
Main Methods:
- Retrospective multicentre cohort study.
- Data collected from 79 women with PAI across 23 UK and Ireland maternity units.
- Analysis of 101 pregnancies, focusing on maternal characteristics, interventions, and outcomes.
Main Results:
- High rates of adrenal crisis (24% of women) and postpartum complications were observed.
- Increased rates of caesarean section (63.9%) and preterm birth (21.2%) noted.
- Inconsistent hydrocortisone dose adjustments and low adherence to steroid emergency card use were identified.
Conclusions:
- Obstetric outcomes for PAI pregnancies are generally favorable but require vigilant monitoring.
- Adrenal crisis remains a significant risk, necessitating reinforced management protocols.
- Recommendations for hydrocortisone dosing and the universal use of NHS steroid warning cards are essential for patient safety.
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