Primary hyperparathyroidism not tied to lower pregnancy rates, worse outcomes for women
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Key takeaways:
- Pregnancy rates did not differ between women with primary hyperparathyroidism and healthy controls.
- There were no differences in most pregnancy and neonatal outcomes between the two groups.
Women with primary hyperparathyroidism have similar pregnancy rates, maternal outcomes and neonatal outcomes as those without primary hyperparathyroidism, according to study data.
“Primary hyperparathyroidism does not seem to alter fertility among women of childbearing age,” Vivek R. Sant, MD, assistant professor of surgery in the division of endocrine surgery, department of surgery at University of Texas Southwestern Medical Center, told Healio. “Women should undergo parathyroidectomy before pregnancy if possible; if discovered during pregnancy, they can safely undergo parathyroidectomy during the second trimester.”
Sant and colleagues conducted a retrospective study of women aged 18 to 44 years with primary hyperparathyroidism. Data were collected from electronic health records in the Kaiser Permanente Southern California health system from 2005 to May 2020. Primary hyperparathyroidism was defined as having a parathyroid hormone level of more than 65 pg/mL within 6 months of an elevated serum calcium level of more than 10.5 mg/dL. Women with primary hyperparathyroidism were matched, 1:3, with a control group of women without primary hyperparathyroidism and two consecutive normal total serum calcium levels measured more than 1 year apart with no recorded hypercalcemia. Pregnancy rates, pregnancy outcomes and neonatal outcomes were obtained from EHRs. Longitudinal calcium levels were recorded.
The study was published in The Journal of Clinical Endocrinology & Metabolism.
There were 386 women with primary hyperparathyroidism matched with 1,158 women without primary hyperparathyroidism. Of those with primary hyperparathyroidism, 235 underwent a parathyroidectomy during follow-up.
The percentage of women who became pregnant was 10.6% in the primary hyperparathyroidism group and 12.8% for the control group. After adjusting for confounders, primary hyperparathyroidism was not associated with a difference in pregnancy rate compared with the control group. The findings were similar in a sensitivity analysis excluding women who underwent a parathyroidectomy. Median peak calcium levels during pregnancy were greater in the primary hyperparathyroidism group compared with control (10.7 mg/dL vs. 9.3 mg/dL; P < .0001).
A lower proportion of women with primary hyperparathyroidism gave birth through vaginal delivery than controls (34.8% vs. 59.5%; P = .03), and median blood loss was lower among the primary hypoparathyroidism group than the control group (500 mL vs. 780 mL; P = .012). No other differences in pregnancy outcomes were observed. There were no differences in any neonatal outcomes between the groups.
“We were surprised to find some women were exposed to primary hyperparathyroidism throughout their entire pregnancy, without apparent difference in outcomes,” Sant said. “However, these were typically women with less severely elevated calcium levels.”
Of 22 women who had a parathyroidectomy performed before pregnancy, 86.4% had a live birth. The median calcium level was 11.3 mg/dL before the procedure and 9.3 mg/dL during pregnancy. Of five women who had a parathyroidectomy performed during the second trimester of pregnancy, the median calcium level was 11.8 mg/dL before the procedure and dropped to 8.8 mg/dL after the procedure and prior to delivery. Four of the five women had a live birth. Among 24 women who did not undergo a parathyroidectomy or had the procedure after pregnancy, median calcium levels were 10.3 mg/dL during pregnancy. Of the group, 79.2% experienced a live birth.
“Hypercalcemia should be worked up with parathyroid hormone level, and patients should be offered a surgical referral if diagnosed with primary hyperparathyroidism,” Sant said. “Parathyroidectomy prior to pregnancy is optimal, although it may be safely performed in the second trimester of surgery if needed.”
Sant said more research is needed to better improve the timing of diagnosis and treatment of primary hyperparathyroidism.
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