Current management and outcome of pregnancies in women with adrenal insufficiency: experience from a multicenter survey
dc.contributor.author | Bothou, C. | |
dc.contributor.author | Anand, G. | |
dc.contributor.author | Li, D. F. | |
dc.contributor.author | Kienitz, T. | |
dc.contributor.author | Seejore, K. | |
dc.contributor.author | Simeoli, C. | |
dc.contributor.author | Ebbehoj, A. | |
dc.contributor.author | Ward, E. G. | |
dc.contributor.author | Paragliola, R. M. | |
dc.contributor.author | Ferrigno, R. | |
dc.contributor.author | Badenhoop, K. | |
dc.contributor.author | Bensing, S. | |
dc.contributor.author | Oksnes, M. | |
dc.contributor.author | Esposito, D. | |
dc.contributor.author | Bergthorsdottir, R. | |
dc.contributor.author | Drake, W. | |
dc.contributor.author | Wahlberg, J. | |
dc.contributor.author | Reisch, N. | |
dc.contributor.author | Hahner, S. | |
dc.contributor.author | Pearce, S. | |
dc.contributor.author | Trainer, Peter J | |
dc.contributor.author | Etzrodt-Walter, G | |
dc.contributor.author | Thalmann, S. P. | |
dc.contributor.author | Saevik, A. B. | |
dc.contributor.author | Husebye, E. | |
dc.contributor.author | Isidori, A. M. | |
dc.contributor.author | Falhammar, H. | |
dc.contributor.author | Meyer, G. | |
dc.contributor.author | Corsello, S. M. | |
dc.contributor.author | Pivonello, R. | |
dc.contributor.author | Murray, R. | |
dc.contributor.author | Bancos, I. | |
dc.contributor.author | Quinkler, M. | |
dc.contributor.author | Beuschlein, F. | |
dc.date.accessioned | 2020-10-06T13:33:46Z | |
dc.date.available | 2020-10-06T13:33:46Z | |
dc.date.issued | 2020 | en |
dc.identifier.citation | Bothou C, Anand G, Li D, Kienitz T, Seejore K, Simeoli C, et al. Current Management and Outcome of Pregnancies in Women With Adrenal Insufficiency: Experience from a Multicenter Survey. J Clin Endocrinol Metab. 2020;105(8):E2853-E63. | en |
dc.identifier.pmid | 32424397 | en |
dc.identifier.doi | 10.1210/clinem/dgaa266 | en |
dc.identifier.uri | http://hdl.handle.net/10541/623332 | |
dc.description.abstract | Context: Appropriate management of adrenal insufficiency (AI) in pregnancy can be challenging due to the rarity of the disease and lack of evidence-based recommendations to guide glucocorticoid and mineralocorticoid dosage adjustment. Objective: Multicenter survey on current clinical approaches in managing AI during pregnancy. Design: Retrospective anonymized data collection from 19 international centers from 2013 to 2019. Setting and patients: 128 pregnancies in 113 women with different causes of AI: Addison disease (44%), secondary AI (25%), congenital adrenal hyperplasia (25%), and acquired AI due to bilateral adrenalectomy (6%). Results: Hydrocortisone (HC) was the most commonly used glucocorticoid in 83% (97/117) of pregnancies. Glucocorticoid dosage was increased at any time during pregnancy in 73/128 (57%) of cases. In these cases, the difference in the daily dose of HC equivalent between baseline and the third trimester was 8.6 ± 5.4 (range 1-30) mg. Fludrocortisone dosage was increased in fewer cases (7/54 during the first trimester, 9/64 during the second trimester, and 9/62 cases during the third trimester). Overall, an adrenal crisis was reported in 9/128 (7%) pregnancies. Cesarean section was the most frequent mode of delivery at 58% (69/118). Fetal complications were reported in 3/120 (3%) and minor maternal complications in 15/120 (13%) pregnancies without fatal outcomes. Conclusions: This survey confirms good maternal and fetal outcome in women with AI managed in specialized endocrine centers. An emphasis on careful endocrine follow-up and repeated patient education is likely to have reduced the risk of adrenal crisis and resulted in positive outcomes. | en |
dc.language.iso | en | en |
dc.relation.url | https://dx.doi.org/10.1210/clinem/dgaa266 | en |
dc.title | Current management and outcome of pregnancies in women with adrenal insufficiency: experience from a multicenter survey | en |
dc.type | Article | en |
dc.contributor.department | Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland. | en |
dc.identifier.journal | Journal of Clinical Endocrinology & Metabolism | en |
dc.description.note | en] |