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Ilia G, Paltoglou G, Chatzakis C, Christopoulos P, Tzitiridou-Chatzopoulou M, Mastorakos G. Increased prevalence of negative pregnancy and fetal outcomes in women with primary adrenal insufficiency. A systematic review and meta-analysis. Endocrine 2024:10.1007/s12020-024-04023-8. [PMID: 39277840 DOI: 10.1007/s12020-024-04023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 08/27/2024] [Indexed: 09/17/2024]
Abstract
Maternal primary adrenal insufficiency (PAI) during pregnancy, due to either Addison disease (AD) or congenital adrenal hyperplasia (CAH), is rare. Only few studies have examined the subsequent important outcomes of maternal glucocorticoid and mineralocorticoid deficiencies during pregnancy upon the fetus and the neonate. Therefore, this systematic review and meta-analysis evaluated the impact of these deficiencies, with data from PubMed/Medline, Cochrane/CENTRAL, and Google Scholar. A total of 31 studies were included for qualitative analysis and 11 for quantitative analysis. Studies examining the prevalence of spontaneous abortion, preterm birth, the occurrence of small for gestational age (SGA) neonates, as well as the neonatal birth weight were included. The systematic review revealed a substantial number of spontaneous abortions, preterm births and SGA neonates in pregnant women with PAI. The meta-analysis showed a mean spontaneous abortion prevalence of 18%, 18% and 17% in women with PAI, AD or CAH, respectively. The mean preterm birth prevalence was 11% when women with AD or CAH were analyzed together, and 13% and 9% in women with AD or CAH, respectively, when these women were analyzed separately. The mean prevalence of SGA neonates was 8% when women with AD or CAH were analyzed together, and 5% and 10% in women with AD or CAH, respectively, when these women were analyzed separately. The mean fetal birth weight was within normalcy in all women with PAI, as well as in women with AD or CAH. In conclusion the executed systematic review of 31 studies followed by a meta-analysis of 11 studies in pregnant women with PAI has shown a greater prevalence of pregnancies with negative outcome (spontaneous abortion, preterm birth) and of negative fetal outcome (SGA) in women with either AD or CAH, as compared to control pregnant women.
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Affiliation(s)
- Georgia Ilia
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
- Department of Obstetrics and Gynecology, Spital Zollikerberg, Zürich, Switzerland.
| | - George Paltoglou
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Faculty of Medicine, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
| | - Christos Chatzakis
- Second Department of Obstetrics and Gynecology, School of Medicine, "Aristotle" University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - George Mastorakos
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Ravichandran L, Paul S, A R, Hs A, Mathai S, Simon A, Danda S, Thomas N, Chapla A. High carrier frequency of CYP21A2 gene mutations in Southern India - underscoring the need for genetic testing in Congenital Adrenal Hyperplasia. Endocrine 2024; 85:363-369. [PMID: 38441846 DOI: 10.1007/s12020-024-03747-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/12/2024] [Indexed: 07/14/2024]
Abstract
PURPOSE Congenital Adrenal Hyperplasia (CAH) is one of the highly prevalent autosomal recessive endocrine disorders. The majority of CAH cases result from mutations in the CYP21A2 gene, leading to 21-hydroxylase deficiency. However, with the pseudogene-associated challenges in CYP21A2 gene analysis, routine genetic diagnostics and carrier screening in CAH are not a part of the first-tier investigations in a clinical setting. Furthermore, there is a lack of data on the carrier frequency for 21-OH deficiency. Therefore, this study is aimed at investigating the carrier frequency of common pseudogene derived CYP21A2 mutations in Southern India. METHODS Recently, a cost-effective Allele-specific PCR based genotyping for CYP21A2 hotspot mutations has been demonstrated to be a highly specific and sensitive assay at the authors' center. Leveraging this approach, a total of 1034 healthy individuals from South India underwent screening to identify the carrier frequency of nine hotspot mutations in the CYP21A2 gene. RESULTS In this study, it was observed that 9.76% of the subjects were carriers for one or more of the nine different CYP21A2 mutations. Among the carriers, the most common was the large 30 kb deletion, followed by II72N, E6 CLUS, and I2G mutations. CONCLUSION We have identified a high prevalence of CYP21A2 mutation carriers in Southern India. These findings emphasize the importance of implementing and expanding cost-effective genetic diagnostics and carrier screening throughout India. Such initiatives would play a crucial role in managing the disease burden, enabling early intervention, and establishing guidelines for CAH newborn genetic screening in the country. This study represents the first carrier screening data on CYP21A2 hotspot mutations from India and is the largest study conducted till date in this context.
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Affiliation(s)
- Lavanya Ravichandran
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
- Ph.D. Programme affiliated to, DBT-Regional Centre for Biotechnology (RCB), Faridabad, Haryana, India
| | - Shriti Paul
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Rekha A
- Department of Medical Genetics, Christian Medical College, Vellore, India
| | - Asha Hs
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Sarah Mathai
- Department of Pediatric Endocrinology, Christian Medical College, Vellore, India
| | - Anna Simon
- Department of Pediatric Endocrinology, Christian Medical College, Vellore, India
| | - Sumita Danda
- Department of Medical Genetics, Christian Medical College, Vellore, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
- DBT, Regional Centre for Biotechnology (RCB), Faridabad, Haryana, India
| | - Aaron Chapla
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India.
- DBT, Regional Centre for Biotechnology (RCB), Faridabad, Haryana, India.
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Ilany J, Cohen O. Assessing the risk of having a child with classic 21-hydroxylase deficiency: a new paradigm. Trends Endocrinol Metab 2021; 32:423-432. [PMID: 33994073 DOI: 10.1016/j.tem.2021.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/14/2021] [Accepted: 04/12/2021] [Indexed: 12/01/2022]
Abstract
Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is a complicated condition genetically, clinically, and treatment wise. Genetically, there are numerus mutations with different effect on enzyme activity that make genetic diagnosis a challenge. Clinically, there are a wide range of presentations from asymptomatic patients to the severe life-threatening classic CAH. Both an asymptomatic heterozygote and a mildly affected non-classical patient can carry a 'severe' mutation and endow it to their offspring. We present a case of non-classic CAH and discuss the problematic relations between biochemical and genetic diagnosis. By integrating the seemingly contradicting literature, we provide a new simple tool to assess the risk of such patients to give birth to a child with classic CAH.
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Affiliation(s)
- Jacob Ilany
- Institute of Endocrinology, Sheba Medical Center, Tel-HaShomer, Israel.
| | - Ohad Cohen
- Institute of Endocrinology, Sheba Medical Center, Tel-HaShomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Badeghiesh A, Ismail S, Baghlaf H, Suarthana E, Dahan MH. Pregnancy, delivery and neonatal outcomes among women with congenital adrenal hyperplasia: a study of a large US database. Reprod Biomed Online 2020; 41:1093-1099. [PMID: 33008769 DOI: 10.1016/j.rbmo.2020.08.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/16/2020] [Accepted: 08/26/2020] [Indexed: 01/27/2023]
Abstract
RESEARCH QUESTION What is the association between congenital adrenal hyperplasia (CAH) and pregnancy, delivery and neonatal outcomes, using a population database cohort. DESIGN Retrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database from 2004-2014. ICD-9 code 255.2 was used to extract the cases of CAH. Pregnancies complicated with CAH were compared with the other pregnancies. All confounding variables were adjusted using multivariate logistic regression, based on any significant differences between the two groups. RESULTS A total of 9,096,788 deliveries occurred during the study period. Two hundred and ninety-nine pregnant women had CAH. Chorioamnionitis was higher in CAH compared with controls after controlling for risk factors (adjusted OR 2.67, 95% CI 1.17 to 6.06). The rates of caesarean section and maternal infection were also higher in CAH than controls (adjusted OR 2.10, 95% CI 1.44 to 3.07 and adjusted OR 2.63, 95% CI 1.22 to 5.63, respectively). Risk of gestational diabetes and pregnancy-induced hypertension rates were not significantly different in CAH (adjusted OR 1.53, 95% CI 0.91 to 2.58 and adjusted OR 0.87, 95% CI 0.49 to 1.56, respectively). At birth, 8% and 2.2% of the neonates were found to be small for gestational age in the CAH and the control groups, respectively (adjusted OR 3.37, 95% CI 1.86 to 6.11). Congenital anomalies were encountered in 2.7% and 0.4% in the CAH and control groups, respectively (adjusted OR 5.24, 95% CI 2.31 to 11.90). CONCLUSIONS Women with CAH were at risk of complications and fetal anomalies. Expected increases in rates of hypertension and gestational diabetes were not encountered. These patients will benefit from surveillance to decrease morbidity.
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MESH Headings
- Adult
- Female
- Humans
- Infant, Newborn
- Pregnancy
- Adrenal Hyperplasia, Congenital/complications
- Adrenal Hyperplasia, Congenital/epidemiology
- Adrenal Hyperplasia, Congenital/therapy
- Case-Control Studies
- Cohort Studies
- Congenital Abnormalities/epidemiology
- Congenital Abnormalities/etiology
- Databases, Factual
- Delivery, Obstetric/methods
- Delivery, Obstetric/statistics & numerical data
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/etiology
- Pregnancy Complications/epidemiology
- Pregnancy Complications/therapy
- Pregnancy Outcome/epidemiology
- Prenatal Care/statistics & numerical data
- Retrospective Studies
- United States/epidemiology
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Affiliation(s)
- Ahmad Badeghiesh
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal Quebec H3A 0G4, Canada; McGill University Health Center, 1001 Decarie Boulevard, Room D05.2519, Montreal QC H4A 3J1.
| | - Sara Ismail
- Faculty of Medicine, McGill University, Montréal Quebec H3G 2M1, Canada
| | - Haitham Baghlaf
- Division of Maternal-Fetal Medicine, Obstetrics & Gynecology Department, University of Toronto, McGill University, Montreal, QC, Canada
| | - Eva Suarthana
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal Quebec H3A 0G4, Canada
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal Quebec H3A 0G4, Canada; MUHC Reproductive Centre, McGill University, Montréal Quebec H2L 4S8, Canada
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Abstract
Fertility rates in classic congenital adrenal hyperplasia caused by 21-hydroxylase deficiency are substantially decreased for various reasons, including hormonal, anatomic, psychosocial, and psychosexual causes. However, fecundity is comparable with the general population. Under optimal hormone replacement, the course and outcome of pregnancies is also good. This article summarizes successful gestational management, including preconceptional considerations, adjustment of hormone replacement during pregnancy, delivery and lactation, as well as the prevention of adrenal crises. In nonclassic 21-hydroxylase deficiency, preconceptional low-dose hydrocortisone replacement normalizes the otherwise increased miscarriage rate. Pregnancy reports in rarer forms of congenital adrenal hyperplasia are summarized as well.
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Affiliation(s)
- Nicole Reisch
- Medizinische Klinik IV, Department of Endocrinology, Klinikum der Universität München, Ziemssenstraße 1, München 80336, Germany.
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