Background/Aim: Maternal primary adrenal insufficiency, has been infrequently described during pregnancy, due to its rarity. Based on the existing literature, maternal hormone deficiency influences pregnancy and has an impact on mother and fetus/neonate, with only a few studies emphasizing on the respective outcomes. The aim of this systematic review and meta-analysis was to evaluate the impact of maternal corticosteroid deficiency during pregnancy on the fetus and the neonate and identify the possible outcomes on this inefficiently studied population.
Materials and Methods: A systematic search was performed in PubMed/Medline, the Cochrane/CENTRAL and the Google Scholar online databases to identify RCTs, cohort studies, case series and case report studies presenting fetal and neonatal outcomes in pregnancies with active maternal primary adrenal insufficiency. After selection, 22 studies were included in the qualitative analysis and 7 studies to the quantitative analysis. Data on the prevalence of miscarriage, preterm birth, the occurrence of small for gestational age (SGA) neonates, as well as the neonatal birth weight were examined.
Results: Maternal primary adrenal insufficiency, presented either as Addisons disease or as Congenital Adrenal Hyperplasia, was associated with high miscarriage rates among PAI patients (22%, 95%CI: 16% to 29%, I2: 67%). A miscarriage rate of 18% (95%CI: 10% to 31%, I2: 82%) and 27% (95%CI: 18% to 40%, I2: 73%) was present among AD and CAH patients, respectively. Prematurity (13%, 95%CI: 11% to 15%, I2: 55%). and SGA neonates (9%, 95%CI: 5% to 16%) occurred among PAI patients, especially when PAI was undiagnosed and untreated. Fetal birth weight was favorable in the majority of the studies (3.238gr, 95%CI: 3.047gr to 3.430gr, I2: 73%). Miscarriage rates in the meta-analyses were higher than those reported in the systematically reviewed studies.
Conclusion: Maternal adrenocortical insufficiency has a higher prevalence of adverse effects on fetal development and pregnancy duration in undiagnosed and untreated women, compared with healthy women or women under treatment. Additional studies on the impact of maternal hormone deficiency on the fetus in a wider range of pregnancies are required to establish the optimal therapy during pregnancy and elucidate underlying mechanisms.
22 Sep 2021 - 26 Sep 2021