ECE2023 Poster Presentations Adrenal and Cardiovascular Endocrinology (72 abstracts)
Pregnancy outcomes in women with classic and non-classic congenital adrenal hyperplasia
Clara Minea 1 , Matthias Auer 1 , Marcus Quinkler 2 , Gesine Meyer 3 , Irina Bancos 4 , Felix Beuschlein 5 , Christina Bothou 5 , Rosario Pivonello 6 , Chiara Simeoli 6 , Henrik Falhammar 7 & Nicole Reisch 1
1Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, Munich, Germany; 2Endocrinology in Charlottenburg, Berlin, Germany; 3Universitätsklinikum Frankfurt, Medizinische Klinik 1 - Schwerpunkt Endokrinologie, Diabetes und Stoffwechsel, Frankfurt, Germany; 4Mayo Clinic, Division of Endocrinology, Metabolism, Diabetes and Nutrition, Rochester, United States; 5Universitätsspital Zürich (USZ), Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Zürich, Switzerland; 6Università Federico II di Napoli, Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Naples, Italy; 7Karolinska University Hospital, Department of Endocrinology, Stockholm, Sweden
Background: There have been conflicting reports on fertility, reproduction rates and pregnancy outcomes in women with congenital adrenal hyperplasia (CAH). Identification of potential modifiable influential factors of pregnancy outcomes in these women has been hampered in the past by either small sample sizes or data derived from epidemiological samples.
Methods: Retrospective multi-center study including a total number of 72 women with CAH (n=34 Non-classic (NC), n=21 simply virilizing (SV), n=17 with salt wasting (SW).) Data on pregnancies were collected using self-designed questionnaires, patients’ and maternity records. In total, 133 pregnancies, 112 live births and 25 abortions were documented.
Results: Median age of the first pregnancy was 30.0 years and did not significantly differ between phenotypes. Across the entire cohort, it took almost two years on average to become pregnant for the first time (median 18.0 months, n.s.). Of all women 83.9% became pregnant spontaneously while the remaining had to use assisted reproductive techniques. The average number of life births of 1.4-1.6 children per woman was similar between all three groups (P=0.813) and comparable to the general population. There was also no significant group difference in terms of spontaneous abortions (0.2-0.6 per women, P=0.360). Most of the children in our cohort were delivered in a timely manner, however, rates of primary cesarean section in all groups were higher than those reported for the general population (NC 45.2%, SV 76.2%, SW 70,6%; P=0.056). Of all children 11.3% in our cohort were small for gestational age (SGA), without a difference between phenotype groups. Gemini pregnancies were documented in 7 cases, 4 of whom had undergone assisted reproduction. Pregnancy complications such as gestational diabetes (n=3) and pre-eclampsia (n=2) were rare. Of the 42 women who had a cesarean section at the birth of their first child, ten were unplanned, including four cases required emergency cesarean section.
Conclusion: Our findings indicate that latency to first pregnancy is still prolonged in patients with CAH independent of phenotype, while fertility rates are comparable to the general population. Rate of primary cesarean sections were not only high in women with classic but also with non-classic CAH.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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