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Cited by 98Sexual Differentiation and DisordersAdrenal Hormones and DisordersOvarian function and disorders

Pregnancy outcomes in women with congenital virilizing adrenal hyperplasia

Lo, Joan C., Grumbach, Melvin M.·2001·Endocrinology and Metabolism Clinics of North America
DOI 10.1016/s0889-8529(08)70027-6
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Abstract

Although low fertility rates have traditionally been reported among women with classic CAH and especially among women with the salt-wasting variant, more recent data suggest that fertility rates are significantly improved, largely owing to earlier treatment of CAH, improved compliance with therapy, and surgical advances in genital reconstruction. Furthermore, ovulation induction and assisted reproductive techniques are now available to women who remain infertile despite effective adrenal androgen suppression. Although the pregnancy experience in women with classic CAH remains limited, it is apparent that, once pregnant, these women have a high probability of successful outcome. Key issues should be emphasized in the management of CAH during gestation, including the need for assessing adrenal steroid replacement and adrenal androgen suppression, particularly in light of the interplay between maternal hyperandrogenism and the protective effect of placental aromatase activity, which provides a relatively large margin of safety for the female fetus. Maternal hormone levels should be evaluated in the context of laboratory-specific reference ranges for pregnancy. The infant should be examined for ambiguous genitalia and monitored for evidence of adrenal insufficiency. Although an affected female infant with classic CAH has not been reported as a pregnancy outcome of a mother with classic virilizing CAH, these concerns should be discussed during preconception counseling. Patients should also be aware of the importance of medication compliance and careful hormonal monitoring during the entire pregnancy. In most cases, successful gestational management requires the close coordination of care between the obstetrician and endocrinologist.

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Crossref · 10.1016/s0889-8529(08)70027-6

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Authors
Lo, J. C., & Grumbach, M. M.
Affiliations
San Francisco General Hospital (US)
Corresponding author
Lo, Joan C.
ORCID
Lo, Joan C.
Venue
Endocrinology and Metabolism Clinics of North America
Publisher
Elsevier BV
Published
2001-03
Volume
30
Issue
1
Pages
207-229
ISSN
0889-8529 (ISSN-L)
DOI
10.1016/s0889-8529(08)70027-6
OpenAlex
W2045187321
Cited by
98
References
144
Citations by year
2026: 1 · 2024: 4 · 2023: 3 · 2022: 3 · 2021: 5 · 2020: 2 · 2019: 5 · 2018: 3 · 2017: 1 · 2016: 5 · 2015: 3 · 2014: 1 · 2013: 4 · 2012: 4
FWCI
2.21
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Endocrinology and Metabolism Clinics of North America (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01hd002335-26)
  • National Center for Research Resources (M01 RR 01271, M01RR001271)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01 HD02335)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
Keywords
congenital adrenal hyperplasia, pregnancy outcomes, placental aromatase, ovulation induction, assisted reproduction, adrenal insufficiency, ambiguous genitalia, preconception counseling, medication adherence
MeSH terms
Adrenal Hyperplasia, Congenital, Female, Embryonic and Fetal Development, Genitalia, Humans, Infant, Newborn, Infertility, Female, Male, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Hyperandrogenism

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