Poster Presentation The Annual Scientific Meeting of the Endocrine Society of Australia and the Society for Reproductive Biology 2014

Management of hypoparathyroidism in pregnancy and lactation - A report of 11 cases (#251)

Brianna L Hatswell 1 , C A Allan 2 3 4 , J Teng 1 2 , P Wong 1 2 3 , P J Fuller 1 2 3 , F Milat 1 2 3
  1. Department of Medicine, Monash University, Clayton
  2. Department of Endocrinology, Monash Health, Clayton
  3. Monash Institute of Medical Research, Prince Henry's Institute, Clayton
  4. Department of Obstetrics and Gynaecology, Monash Health, Clayton

Hypoparathyroidism is rare in pregnancy with limited case reports and no established management guidelines reported in the literature. However, hypoparathyroidism is important as it is associated with maternal morbidity and fetal loss. Optimal maintenance of calcium levels within lower normal range during pregnancy is required to minimise risk of related complications. Variable responses to calcitriol and calcium, and altered calcium homeostasis during pregnancy and lactation make the management of this condition challenging.  Monash Health's maternity service is the largest maternity provider in Victoria, with an associated database that captures birthing outcomes in over 9,000 women each year. We audited the database between 2000-2014 to examine the clinical course, treatment, and maternal and fetal outcomes of pregnant women with hypoparathyroidism.  We identified 11 pregnancies from 6 women with pre-existing hypoparathyroidism secondary to thyroid surgery for Graves disease (n=3) and thyroid cancer (n=1), DiGeorge syndrome (n=3), idiopathic hypoparathyroidism (n=3), and familial hypoparathyroidism (subsequently diagnosed with autosomal dominant hypocalcemia with hypercalciuria) (n=1). In all cases, maternal calcium levels were monitored through pregnancy, and calcitriol and calcium doses adjusted to maintain normocalcemia. One woman delivered by caesarean section at 34 weeks gestation in the setting of IUGR and oligohydramnios in two pregnancies. The perinatal course was otherwise uneventful in the remaining pregnancies. The postpartum period was complicated by severe hypercalcemia in one woman 9 days postpartum and by symptomatic, labile serum calcium levels during lactation in another woman which required close monitoring over a 6 month period. Although rare, hypoparathyroidism in pregnancy poses a management challenge for clinicians and co-ordinated care is required between obstetricians and endocrinologists to ensure optimal outcomes for mother and baby. Continued monitoring of maternal calcium levels during lactation and weaning is required to avoid the potential complications of hypercalcemia or hypocalcemia.