Table of Contents
Introduction
The endocrine system is significantly impacted by pregnancy. Many hormones undergo changes during pregnancy in their synthesis, metabolism, and binding. Pregnancy-induced immunological tolerance has been shown to affect the progression of autoimmune endocrine illnesses including Graves' disease.
The placenta secretes several hormones, including human chorionic gonadotropin (hCG), human placental lactogen, growth hormone, estrogen, and progesterone, all of which have downstream effects on other hormonal axes. The diagnosis and treatment of pregnant women with endocrine disorders must take into account pregnancy-specific hormonal changes, as well as the effects of any diagnostic or therapeutic procedures on both the mother and the fetus.
What Endocrine Changes Occur During Pregnancy?
The placenta serves as a temporary endocrine (hormone-producing) gland during pregnancy, connecting the unborn child to the blood supply and secreting substantial amounts of estrogen and progesterone to support uterine growth.
Pregnancy-related hormonal changes impact every system in the body. The endocrine system reacts in the following ways during pregnancy:
-
Pregnant women may experience hot flashes or warmer sensations due to changes in their hormone levels and metabolic rates.
-
The parathyroid gland expands to accommodate increased calcium requirements.
-
The posterior pituitary gland releases oxytocin to initiate labor when the baby is ready to be born.
-
Prolactin is a hormone that the anterior pituitary secretes at birth to encourage the production of breast milk.
What Are Endocrine Diseases That Occur in Pregnancy?
1. Diabetes Insipidus
Pregnancy-related placental vasopressin as production and a corresponding drop in antidiuretic hormone (ADH) levels might exacerbate the symptoms of diabetes insipidus. Desmopressin is an example of an ADH analog that can be sustained with no documented side effects, but pregnant women may need a greater dosage than usual.
After delivery, it is crucial to promptly reduce the dose. Pregnancy-related temporary diabetes insipidus can develop as a result of placental vasopressin. This may be a symptom of severe liver disease, such as acute fatty liver in pregnancy. Diabetes insipidus can be accompanied by decreased oxytocin production because it is a posterior pituitary condition.
2. Parathyroid Disease and Calcium Metabolism
- Hyperparathyroidism: Up to 25 percent of pregnancies are accompanied by either hypertension or pre-eclampsia. Maternal mortality due to pancreatitis or hypercalcemic crises. When maternal hypercalcemia is severe (more than 3.5 mmol/l), there is a noticeable relation to fetal morbidity with mortality rates of up to 40 percent. A higher risk of miscarriage, intrauterine growth restriction, stillbirth, newborn tetany, and neonatal mortality is also present. It might be challenging to diagnose hypercalcemia during pregnancy since the reduced albumin content can make the total calcium concentration seem normal.
3. Thyroid Disease
- Hypothyroidism:
Up to one percent of pregnant women have hypothyroidism, but the majority of them were diagnosed and received treatment prior to being pregnant. Lethargy, weight gain, and constipation are among the many typical clinical signs of hypothyroidism that are present in healthy pregnancies. Cold intolerance, bradycardia, and delayed tendon reflex relaxation are more specific symptoms. Hence, elevated thyroid-stimulating hormone (TSH) and low-free thyroxine (fT4) concentrations are used to make the diagnosis.
Due to ovulation suppression, untreated hypothyroidism can cause amenorrhea and infertility. Following conception, it is linked to a higher incidence of miscarriage, anemia, pre-eclampsia, and babies with low birth weight. If severe, maternal iodine shortage can harm the developing fetus and cause newborn hypothyroidism with poor cognitive and physical growth.
Levothyroxine can be started in patients with hypothyroidism who have been diagnosed during pregnancy as it is safe and suitable for usage throughout that time. Levothyroxine is secreted into breast milk, but not in quantities high enough to interfere with the thyroid function of a newborn. As a result, breastfeeding can continue as usual.
- Hyperthyroidism:
If untreated, pre-existing hyperthyroidism can cause infertility. Miscarriage, premature labor, and fetal growth restriction that are linked to uncontrolled disease are less common if proper therapy is started along with normalization of thyroid function. Due to certain immunosuppression that occurs during pregnancy, autoimmune thyrotoxicosis may improve, but there is a chance that it will worsen after birth.
During pregnancy, Carbimazole and Propylthiouracil (PTU) are both safe to use. Both pass through the placenta, but none are particularly teratogenic. When hyperthyroidism is discovered in the first trimester, PTU is the drug of choice because Carbimazole is extremely infrequently linked to aplasia cutis and choanal atresia. However, if a woman had successfully used Carbimazole to treat her hyperthyroidism before becoming pregnant, she should continue to do so to keep it under good control.
4. Adrenal illness
- Cushing's Syndrome
There are overlaps between the clinical signs of pregnancy and those of hypercortisolemia, such as weight increase, tiredness, glucose intolerance, and hypertension. Contrary to pituitary adenomas, adrenal adenomas are more frequently the cause of Cushing's syndrome in pregnant women. Both the plasma and urine cortisol concentrations change throughout pregnancy, but a high-dose Dexamethasone suppression test that measures cortisol production suppression shows no effect is consistent with adrenal hypercortisolemia. Increased risk of pre-eclampsia, gestational diabetes mellitus, fetal loss, and preterm delivery are linked to Cushing's syndrome.
- Congenital Adrenal Hyperplasia
Congenital adrenal hyperplasia (CAH) is a collection of conditions characterized by enzymatic abnormalities in the manufacture of adrenal steroid hormones. The most commonly used in order are 21-hydroxylase deficiency and 11-hydroxylase deficiency. There is a link between subfertility and congenital adrenal hyperplasia. Cephalopelvic disproportion, which can be brought on by the android pelvis and can be impacted by prior genital surgery, might make delivery challenging. Pregnancy-related hypertension and gestational diabetes mellitus are two more conditions that are more likely to affect women with congenital adrenal hyperplasia.
Conclusion
Consultations during pregnancy are frequently requested due to endocrine problems. When not treated properly, several of these diseases, which are prevalent in women of reproductive age, can have a significant negative influence on fertility and the success of pregnancies. Breastfeeding assistance, guidance on effective contraception, and lifestyle recommendations (diet, smoking, exercise) should all be provided to women with endocrine diseases. Prior to leaving maternity care, the medication regimen should be examined and the proper endocrine follow-up scheduled. Postnatal care will vary depending on the endocrine disorder. Individualized management is necessary. To know more about this condition, consult the doctor online.
