Endocrine Abstracts

Objective: To determine characteristics and outcomes of pregnancy in women with Primary Adrenal Insufficiency (PAI)

Design: Retrospective multicentre cohort study

Setting: 23 maternity units; UK and Ireland

Sample: 79 women with Primary Adrenal insufficiency (PAI) with 101 pregnancies

Main outcome measures: Adrenal crisis, pregnancy outcome

Results: Date were obtained on 101 pregnancies in 79 women with PAI. Most (51, 64.1%) had autoimmune disease, eight (10.3%) had prior adrenal infarction/surgery/haemorrhage, two had (2.6%) congenital adrenal hyperplasia and 18 were (21.3%) unclassified. 19 (24%) experienced adrenal crisis during pregnancy (18.8% of pregnancies). One woman died postpartum. Although all had recorded endocrinology input during pregnancy, steroid alert cards were documented to be carried in 40 (39.6%) pregnancies and only 9/19 (47.4%) of those with an adrenal crisis in pregnancy. Compared with pre-pregnancy dose, only 41% of women received increased hydrocortisone dose in pregnancy. Caesarean section rate was higher than UK average 62/97 (63.9%). Preterm birth rate was 21.2% (21/99) and 12.8% (12/94) of neonates had birthweight < 10^thcentile.

Conclusion: Whilst the obstetric outcome of pregnancy with PAI is generally favourable, there are high rates of caesarean birth and prematurity. However, a high number of women experienced adrenal crisis yet the minority carried steroid alert cards. Recommendations regarding third trimester increases in hydrocortisone should be reviewed and potentially strengthened, in light of further evidence. All pregnant women with adrenal insufficiency should carry an NHS steroid warning card; this should be reinforced both by endocrine and obstetric teams because of the increased risk of life-threatening adrenal crisis.