Characteristics and Pregnancy Outcomes in Women with Primary Adrenal Insufficiency

The present study investigated the characteristics and pregnancy outcomes in women with primary adrenal insufficiency (PAI). This retrospective multicenter cohort study included 79 women with PAI who experienced a total of 101 pregnancies. Data were collected through retrospective chart analysis and main outcome measures were adrenal crises and pregnancy outcomes.

The results showed the following:

Data from 101 pregnancies in 79 women with PAI were analyzed.
The majority (64.1%) had autoimmune conditions, while others had a history of adrenal infarction, surgery, or congenital adrenal hyperplasia.
During the study, 24% of women experienced an adrenal crisis (18.8% of pregnancies).
There was one postpartum death.
Although all participants received endocrinology care during pregnancy, only 39.6% carried steroid emergency cards, and 47.4% of those who faced an adrenal crisis had such cards.
Only 41% of women had an increased hydrocortisone dose during pregnancy compared to their pre-pregnancy dosage.
The cesarean section rate was notably high at 63.9%, and 21.2% of births were preterm, with 12.8% of neonates classified as having a birthweight below the 10th percentile.

To conclude, while pregnancy outcomes for women with PAI are generally positive, there are significant rates of cesarean sections and preterm births, alongside a concerning incidence of adrenal crises. There is a need for further investigation into the management of hydrocortisone dosing in the third trimester. It is crucial for pregnant women with adrenal insufficiency to carry an NHS steroid warning card, with reinforcement of this practice by both endocrine and obstetric teams to mitigate the risk of life-threatening adrenal crises.

Source: Cauldwell M, Steer PJ, Ahsan M, Ali A, Ashiq S, Ashworth R, Basha D, Chong H, Corbett GA, Dunn F, Hill A, Gajewska-Knapik K, Jakes A, McLaren D, Kinsella T, Lee T, Levy M, MacKiliop L, McAuliffe FM, Mohan A, Mumby C, Nana M, Napier C, Neuberger F, Newman C, Oosterhouse T, Shard A, Shehata H, Stocker L, Tomlinson JW, Beck A, Vaidya B, Wiles K, Williamson C, Zollner J, Ward E, Turner HE. Pregnancy Outcomes in Women With Primary Adrenal Insufficiency: Data From a Multicentre Cohort Study. BJOG. 2025 Mar 30. doi: 10.1111/1471-0528.18143. Epub ahead of print. PMID: 40159596.

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