Hypercalcemia during pregnancy: management and outcomes for mother and child

Abstract

Diagnosing and treating hypercalcemia during pregnancy can be challenging due to both the physiological changes in calcium homeostasis and the underlying cause for the hypercalcemia. During pregnancy and lactation there is increased mobilization of calcium in the mother to meet the fetus’ calcium requirements. Here we discuss the diagnostic challenges, management, and patient perspective of hypercalcemia during pregnancy in two particular cases and in other rare conditions causing hypercalcemia.

European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE Educational Program of Parathyroid Disorders (PARAT 2021)

“…Changes in bone and mineral metabolism during pregnancy and lactation occur to ensure an adequate mineral supply to meet the growing needs of the fetal skeleton and the newborns while preserving maternal health (Fig. 5) (4,5,8,156,157,158). During pregnancy, the plasma volume expansion with subsequently reduced albumin levels causes a decrease in total calcium concentrations.…”

“…During pregnancy, maternal PTH, which does not cross the placenta, is usually suppressed to the lower normal range or even below, while 25(OH)D remains materially unchanged and 1,25(OH) 2 D increases two-to three-fold (158). Parathyroid hormone-related peptide (PTHrP) that is virtually not detected in non-pregnant women increases steadily during pregnancy and appears to be mainly produced by breast tissue and placenta (5,158). The precise physiological role of PTHrP is still not fully clarified but has been shown to exert PTH-like effects.…”

“…The precise physiological role of PTHrP is still not fully clarified but has been shown to exert PTH-like effects. Excess PTHrP production may cause hypercalcemia, a disease termed 'pseudohyperparathyroidism' (5,158). During lactation, PTHrP release is stimulated via suckling and high prolactin, as exemplified by the successful treatment of pseudohyperparathyroidism with prolactinsuppressing dopamine agonists (8,162).…”

“…In this transition period, there is a need for guidance and recommendations on long-term management of HypoPT, as well as there is a need for improvements of surgical management on the thyroid and parathyroid glands, in order to prevent HypoPT. As many patients with parathyroid disorders are diagnosed before or during fertile age, special attention should be paid to the course of pregnancy, from the planning period to the end of lactation (4,5,6,7). Major calcium metabolic changes develop in pregnancy and during lactation ensuring mineralization of the skeleton in the fetus and newborns, mainly driven by the PTH-related peptide (PTHrP).…”

Parathyroid Disease in Pregnancy and Lactation: A Narrative Review of the Literature

“…PTHrP-induced hypercalcemia during lactation has been reported especially in the setting of gigantomastia and resolved only after mastectomy or bromocriptine administration [ 81 , 82 , 83 ]. Thus, women with gestational hypercalcemia and gigantomastia should be especially advised against breastfeeding [ 84 ]. In addition to recommendations with regard to breastfeeding, surgery should be scheduled during the postpartum period.…”