Endocrine Abstracts

Background: Non-classical 21-hydroxylase deficiency (NC21OHD) is a mild form of congenital adrenal hyperplasia associated with different degrees of postnatal virilisation. Elevated serum androgen concentrations have been reported to be a risk factor for infertility, early pregnancy loss, and recurrent miscarriages in women with polycystic ovarian syndrome (PCOS).

Aims: The aim of this study was to assess time to conceive and pregnancy outcome in NC21OHD women in correlation with glucocorticoid (GC) therapy and androgen levels.

Patients and methods: We conducted a retrospective observational study in a tertiary medical centre. The outcome of 130 pregnancies among 59 women (mean age at diagnosis 20±9.5 years and mean age at first pregnancy 29±5years) with biochemical and genetic diagnosis of NC21OHD was reviewed. Androgen and 17OHP levels were measured before and during each trimester. The mean GC dose was 7.4±3.3 mg hydrocortisone/m².

Results: There was no difference in time to conceive between pregnancies of women with and without treatment (7.7±11 months vs 7.5±25 months). There were 29 pregnancies without GC therapy and 101 with GC therapy. There was no significant difference between the rate of miscarriages between treated and untreated pregnancies (25% vs 17%, respectively, P=0.6). Birth weight was significantly lower in GC-treated pregnancies compared to untreated pregnancies (2.9±0.4 kg vs 3.2±0.5 kg, respectively, P=0.03). Androgen and 17OHP levels were similar in pregnancies that ended with miscarriage and those that ended with live birth.

Conclusions: Time to conceive is similar between treated and untreated pregnancies in NC21OHD women. In contrast to previous reports, there was no difference in miscarriage rates between treated and untreated pregnancies. There was significant decrease in birth weight in treated pregnancies despite the use of low doses of GC.