Endocrine Disorders In Pregnancy

A quickening moment in the abdomen is a lifetime bliss for a woman experiencing pregnancy. This phase is an eternal remembrance in her heart, even when the age fades! Two heartbeats within one, growing to be the future that she won.

Motherhood, a pregnant woman's destination, making it through the nausea and swollen ankles to cramps and labor pain, finally for the birth of a new beginning.

Rapid changes in her endocrine system goes through during the development of her bundle of joy. However, occurrence of preexisting or new health condition may vandalize her life, but a Mother takes it all!

Endocrine System The endocrine system is composed of a constellation of glands like pituitary, adrenal, thyroid, parathyroid, gonads, pancreas, pineal and cells that produce hormones. These hormones are signaling molecules released in the blood that travels throughout the body acting on respective target cells or organs. This systems function is to help various activities such as growth control, sexual development, maintenance of pregnancy and other bodily metabolism. Various factors may contribute to the rise of endocrine disorders whether be it, abnormal release of hormones, inappropriate response to signaling or lack of a gland.

Endocrine Disorders in Pregnancy
During the phases of pregnancy, the physiology of endocrine system changes constantly in the mother and fetus as several endocrine functions are altered, The changes associated with pregnancy can as well alter the clinical progression of endocrine abnormalities, demanding close antenatal and postnatal monitoring. However, it is a challenge to distinguish between the manifestation of diseases and normal hypermetabolic state (increased rate of metabolic activity) during pregnancy.

Major disorders associated with different endocrine glands during pregnancy are

1. Pituitary Disorders

• Prolactinomas Prolactin is a hormone that maintains normal lactation and milk production Prolactinoma is a benign tumor (adenoma) known to be a prominent pituitary disorder in pregnancy and is a common cause of reproductive and sexual dysfunction. It is necessary that hyperprolactinaemia (higher than normal reference levels of the hormone prolactin in blood) should be maintained for ovulation and fertility process. Altered levels of prolactin is mainly responsible for infertility as it inhibits the release of pulsatile gonadotrophin releasing hormone from Prolactinoma hypothalamus, which is responsible for the synthesis of LH and FSH hormones.
• Acromegaly A hormonal disorder wherein fertility is impaired. Pregnancy in acromegalic woman is very rare and to conceive, prolactin (PRL) and growth hormone (HGH) levels should be normalized to promote fertility. It is related to the excessive production of growth hormone (GH) by the pituitary gland and this excess GH usually develops from a benign pituitary tumor (adenoma). Patients with microadenoma during pregnancy should discontinue medical treatments and a strict assessment at each trimester is suggested. Increased chances of infertility, pituitary enlargement and visual impairment during gestation is seen if tumor removal in macroadenoma patients is done before conception.

2. Thyroid Disorders

• Hyperthyroidism It is seen in 0.2% of pregnancy cases, where almost 95% of it are secondary to Graves disease. The autoimmune disorder Graves disease is attributed to be the major cause of maternal hyperthyroidism during pregnancy. A condition where the body makes an antibody thyroid stimulating immunoglobulin (TSI) to attack its own system, instead of responding to foreign particles. In a mother with Graves disease, over production of TSI can also cross the placenta and cause fetal hyperthyroidism Hyperthyroidism if untreated, manifests adverse consequences on maternal health and fetal outcome that includes increased risk of maternal congestive cardiac failure preeclampsia (pregnancy complication due to High blood pressure), low birth weight in infants, premature labor, and perinatal mortality, Additionally, the chances of goiter formation is higher in iodine-deficient pregnant women.
• Hypothyroidism Seen in 2.5% of pregnancy cases, such woman possesses 2-fold greater risk of ovulatory infertility. Common cause of this condition is the autoimmune disorder known as Hashimoto's thyroiditis wherein the body attacks its own cells of thyroid gland. This results, in the lack of enough cells and enzymes in the thyroid gland for production of hormones to satisfy the body's needs. After conception, untreated hypothyroidism poses higher risk of spontaneous abortion, preeclampsia, anemia, still births as well as congenital anomalies and low birth weight in infants.

3. Adrenal Gland Disorder

• Congenital Adrenal Hyperplasia (CAH) CAH is a group of inherited disorders of the adrenal gland, which are associated with deficiencies in enzymes required for the production of steroid hormones. 21 hydroxylase deficiency, is the most common form and is prevalent in more than 90% of CAH in pregnancy. Gestational management involving adequate steroid replacement is necessary in these pregnancies.

4. Parathyroid Disorders

• Hyperparathyroidism During pregnancy, it can lead to various conditions like pancreatitis, hypercalcaemig crisis, and toxaemia. If maternal calcium levels are elevated, there could be an increased incidence of preterm delivery and neonatal hypercalcaemia. calcium levels should be measured regularly and surgical measures, if required, can be undertaken safely in the second trimester.
• Hypoparathyroidism Generally, it is caused due to damage or removal of parathyroid glands while operating on the thyroid gland. Hypoparathyroidism sufferer may complain of carpopedal spasm, laryngeal stridor, and dyspnea. Further, severe cases may leads to convulsions. Other symptoms include irritability, depression, and memory impairment. If mother is not treated, hypoparathyroidism along with decline in maternal calcium levels results in fetal hypocalcemia causing intrauterine hypoparathyroidism along with skeletal demineralization subperiosteal bone resorption, and osteitis fibrosa cystica.

5. Pancreatic Disorder

• Acute Pancreatitis A condition which results in the sudden inflammation of pancreas, having symptoms like abdominal pain, dehydration, nausea, that can progress to a severe form of the disease leading to death. Prevalence of this disease in pregnancy is very rare and is caused due to gallbladder stones. Hormonal changes of pregnancy contribute to form gallstones which travel to the common bile duct and obstruct the pancreatic outflow.

Management of Endocrine Disorders in Pregnancy
Educating the patient about the maternal changes during pregnancy is essential to cope up with the gestational period. Preconception screening and timely checkup is advised as a safety measure to foster betterment of the next generation. Physician's complete knowledge on drugs consumed by the mother is a good practice to avoid the risk of various side effects to the mother and fetus. Sharing information about the compatibility, complications and excretion of the drug would pave the way to cautiousness for pregnancy. Skilled care during pregnancy, is however, recommended for those who are weak or dealing with a complicated pregnancy.