A Retrospective Study on the Impact of Primary Aldosteronism in Pregnancy (H.A.P.P.I. Study Group)

Primary aldosteronism (PA) is a common cause of hypertension in young women. However, there is a paucity of data regarding its impact during pregnancy. The primary objective of this study was to describe the occurrence of hypertensive disorders of pregnancy (HDP) in PA.

This retrospective cohort study compared outcomes in pregnancies according to PA status.

Pregnancies occurred between 2011 and 2022 at the Centre Hospitalier Universitaire de Sherbrooke. All selected pregnancies were screened for PA with an aldosterone-to-renin ratio (ARR) within a 5-year period. Pregnancies with more than two fetuses and with other endocrinopathies were excluded.

To ascertain PA diagnosis, ARR measurements were conducted, followed by a confirmatory test if abnormal.

Among 226 studied pregnancies, 15 (6.6%) were diagnosed with PA. In the PA group, pre-eclampsia was diagnosed in 46.7% of pregnancies (vs. 30.8%, p = 0.252), while gestational hypertension was diagnosed in 0.0% of pregnancies (vs. 16.6%, p = 0.136). Post-partum HDP occurred in 40.0% of pregnancies with PA (vs 19.4%, p = 0.093). Additionally, 40.0% and 13.3% of pregnancies with PA respectively required intravenous antihypertensive treatment (vs. 24.2%, p = 0.216) and intensive care admission (vs. 3.3%, p = 0.113).

A trend towards an increased incidence of postpartum and severe pre-eclampsia was noted in the PA group.