Endocrine Disease

Abstract

Endocrine disease has become increasingly prevalent in parturients, primarily due to the increase in prevalence of diabetes mellitus. Both preexisting diabetes mellitus and gestational diabetes mellitus are associated with significant maternal and fetal complications. The Hyperglycemia and Adverse Pregnancy Outcome study demonstrated that not only was the presence of diabetes mellitus associated with complications during pregnancy but the degree of glycemic control also had an effect on the development of adverse events. Other than diabetes mellitus, the next most common endocrine disease encountered during pregnancy is thyroid disease, with hypothyroidism being more common than hyperthyroidism. Overt hypothyroidism has been shown to be associated with premature birth, low birth weight, pregnancy loss, reduction in offspring IQ, and the development of pregnancy-induced hypertension and, therefore, requires levothyroxine therapy throughout pregnancy. Hyperthyroidism is similarly associated with premature birth, low birth weight, pregnancy loss, hypertensive disorders during pregnancy, gestational diabetes mellitus, maternal heart failure, transient fetal hypothyroidism, neonatal Graves disease, and neonatal mortality. Additional endocrine diseases encountered in pregnancy include pheochromocytomas, prolactinomas, and primary hyperparathyroidism. Due to the rarity of these diseases, diagnosis is often delayed and can result in poor maternal and fetal outcomes. This review contains 6 figures, 5 tables, and 38 references. Key Words: diabetes, gestational, hyperglycemia, hyperparathyroidism, hyperthyroidism, hypothyroidism, pheochromocytoma, prolactinoma