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Childbirth complication rate low in women with primary hyperparathyroidism
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Gestational primary hyperparathyroidism is uncommon and, in general, not linked to an elevated risk for obstetrical complications, according to recent findings.
“The aim of the present retrospective study was to evaluate the rate of obstetrical complications and pregnancy loss in a large cohort of women with a proven diagnosis of [primary hyperparathyroidism] during gestation, in relation to clinical and laboratory parameters,” the researchers wrote.
In the study, Dania Hirsch, MD, of Rabin Medical Center and Beilinson Hospital in Israel, and colleagues evaluated all women of reproductive age (n = 292,024) who underwent serum calcium measurement at the central laboratory of Maccabi Healthcare Services between 2005 and 2013.
Women identified for inclusion of the final study sample met the following criteria: primary hyperparathyroidism diagnosed before, during or after pregnancies that occurred during the period of study; first elevated serum calcium levels identified before or during the first pregnancy; and not having undergone successful parathyroidectomy before the pregnancies included in the analysis.
The researchers identified 124 participants who became pregnant at the time of hypercalcemia (study group) and compared pregnancy outcomes with a control group of 175 normocalcemic pregnant women (controls) who conceived during the same study period.
The researchers found that 88.7% of pregnancies in the study group resulted in term delivery of apparently healthy newborns. Abortion occurred in 9.7% pregnancies and preterm deliveries occurred in 1.6%. The following additional obstetrical complications occurred in 13.7% of the pregnancies: cesarean section (7.3%), vacuum delivery (2.4%), gestational hypertension (1.6%), large-for-gestational-age newborns (1.6%) and polyhydramnios (0.8%). None of the women experienced a hypercalcemic crisis or acute pancreatitis.
In the control group, 87.8% of pregnancies ended in term delivery of apparently healthy newborns. Abortions occurred in 10.9% of pregnancies and preterm delivery occurred in 1.4%. Additional obstetrical complications were seen in 11.1% of pregnancies and primary consisted of nonelective cesarean section (8.1%).
No significant differences were seen between the study and control groups in pregnancy loss rates or all obstetrical complications.
Among participants with hypercalcemia, it was first identified during pregnancy in 14 of 74 participants and before pregnancy in 60 participants. Serum calcium was measured prenatally in 46% of 124 participants. Assessment of serum parathyroid hormone concentration resulting in diagnosis of primary hyperparathyroidism was performed during the first evaluated pregnancy in 17 of 74 participants, before pregnancy in 23 participants and after birth in 34 participants.
Parathyroidectomy was performed in 43 participants and six of these were performed during pregnancy without complications to the mother or baby.
No significant correlation was reported between calcium levels during pregnancy and pregnancy outcomes.
“The present study shows that most women with [primary hyperparathyroidism] during pregnancy have only mild hypercalcemia that is generally not associated with an increased risk of abortion or any obstetrical complication,” the researchers wrote. “Owing to the small number of women with severe hypercalcemia in our cohort, we were unable to analyze its potential effect on pregnancy outcomes or the potential beneficial impact of surgery in reducing the risk of abortions in this minority of patients.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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