Pregnancy outcomes in women with primary hyperparathyroidism

Abstract

Objective: To study pregnancy and pregnancy outcomes in women with primary hyperparathyroidism (PHPT) and in controls. Design: Register-based retrospective cohort study of women aged 16-44 years with a diagnosis of PHPT with age-and gender-matched non-exposed controls in Denmark. Methods: The patients and controls were identified using the Danish National Hospital Discharge Register for the period 1977-2010. The outcomes were determined using the Birth Register, the Abortion Register and the LPR (National Hospital Discharge Register). The primary outcome was the relative risk of abortions in patients compared with controls. Results: A total of 1057 women with PHPT and 3171 controls were identified. The number of women giving birth and experiencing abortions did not differ between the two groups (live births, PZ0.21 and abortions, PZ0.12). Also birth weight, length, Apgar score, and gestation length at abortion did not differ. Within the first year after the diagnosis was made, gestation length was lower in women with PHPT than that in controls. However, this was linked to more deliveries by caesarian sections. Conclusions: A diagnosis of PHPT did not seem to increase the rate of abortions in our study. Reducing the abortion risk may therefore not be an indication for parathyroidectomy during pregnancy in patients with mild PHPT. The PHPT diagnosis does not seem to affect birth weight, length and Apgar score. The higher number of deliveries by cesarean section after the diagnosis was made may be associated with lower gestation age. The strategy for delivery should be carefully considered in pregnant women with PHPT.

Pregnancy Outcomes in Women With Primary Hyperparathyroidism

“…Only two studies to date have investigated the rate of pregnancy loss in women with gestational PHPT, and there were conflicting results (5,8). Norman et al (5) reported a 3.5-fold higher-than-normal rate of miscarriages among 77 pregnancies in 32 women with gestational PHPT from a single practice and suggested that surgical intervention in the second trimester might reduce the risk.…”

Primary Hyperparathyroidism In A First-Trimester Woman With Hyperemesis Gravidarum And Pancreatitis

“…One study reported that primary hyperparathyroidism is associated with a 3-to 5-fold increased risk of miscarriage, primarily in the second trimester, and more likely in severe cases (serum calcium level >11.4 mg/dL) (4). Another study suggested that mildly affected patients do not have an increased risk of abortion (5). Up to 50% of neonates experience postpartum hypocalcemia secondary to elevated maternal calcium levels that suppress the fetal parathyroid glands (3).…”

“…Conservative medical therapy should be considered in the asymptomatic patient with a calcium level of <11 to 12 mg/dL (2,5). This includes a low-calcium diet and aggressive hydration, with or without a loop diuretic (2).…”

“…The upper limit of normal for total serum calcium is 9.5 mg/dL in pregnancy (13). Parathyroidectomy is generally recommended for pregnant patients with calcium levels >11 mg/dL, particularly in patients with prior pregnancy loss (5). It is traditionally done during the second trimester, given the higher risk in the first and third trimesters (9).…”

Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

“…22,23 PHPT is rare in pregnancy and is frequently associated, if unknown and untreated, with the risk of fetal complication and abortion: another register-based retrospective cohort study demonstrates how diagnosis of PHPT does not seem to increase the risk of abortion neither birth weight, length or Apgar score. 24 Neonatal primary hyperparathyroidism and familial hypocalciuric hypercalcemia are rare conditions caused by a defect in the gene coding for the calcium sensing receptor. In the first case newborns presented with hypotonia, poor feeding, constipation and respiratory distress: it is usually due to a homozygous mutation of calcium sensing receptor gene.…”