Outcomes of Primary Hyperparathyroidism Treatments During Pregnancy
Maternofetal outcomes have improved relative to those in early literature in patients treated medically and surgically for hyperparathyroidism during pregnancy.
Patients who develop primary hyperparathyroidism during pregnancy predominantly treat the condition medically, but surgery is an option. The results of a retrospective chart review analyzing maternofetal outcomes for both treatment options were published in The Journal of Clinical Endocrinology and Metabolism.
Researchers in this study evaluated 28 pregnancies for maternal characteristics and pregnancy and neonatal outcomes. Maternal characteristics included demographic information, health history, blood assays, and medical or surgical treatment of hyperparathyroidism details. Pregnancy outcomes included information on delivery, gestational age, and any delivery complications. Neonatal outcomes included birth weight, hypocalcemia, and neonatal intensive care unit stays.
The cohort was categorized into groups of medically treated and diagnosed before 28 weeks of gestation (n = 12), medically treated and diagnosed after 28 weeks of gestation (n = 10), and surgically treated (n = 6).
The mean maternal serum calcium concentration was 2.7 mmol/L for those medically treated and diagnosed before 28 weeks gestation, 2.9 mmol/L for those medically treated and diagnosed after 28 weeks gestation, and 2.9 mmol/L for participants treated with surgery. For surgically treated patients, the mean gestation age was 24 weeks, and post-surgery serum calcium and primary hyperparathyroidism levels were normal with no maternal or fetal complications. Pre-eclampsia occurred in 30% of the patients medically treated, and maternal hypertension was an indication for delivery in 7 (35%) of the pregnancies, with 20% of the deliveries occurring before 37 weeks. Pre-eclampsia did not occur in the patients surgically treated, but maternal hypertension was the cause for delivery in 2 (33%) of the pregnancies.
A caesarean section occurred in 50% of all the deliveries, with 3 occurring because of hypertension in patients medically treated. There were 2 early miscarriages that occurred at weeks 12 and 13 with serum calcium levels of 2.57 mmol/L and 2.78 mmol/L, respectively. Four neonates of patients medically treated required neonatal intensive care unit admission for prematurity complications with a mean stay of 19.8 days. One neonate of a patient surgically treated required a neonatal intensive care unit admission for 32 days.
The investigators called for future studies with increased sample size and evaluation of optimal timing for surgery in later stages of pregnancy.
Researchers concluded that “maternofetal outcomes have improved relative to [those] in early medical literature in medically and surgically managed patients, but the rate of pre-eclampsia and [preterm] delivery was higher in medically managed patients.”
Rigg J, Gilbertson E, Barrett HL, Britten F, Lust, K. Primary hyperparathyroidism in pregnancy: maternofetal outcomes at the Royal Brisbane and Women's Hospital 2000 to 2015 [published Sept. 21, 2018]. J Clin Endocrinol Metab. doi:10.1210/jc.2018-01104