Outcomes of Hypoparathyroidism in Pregnancy: A Retrospective Analysis from a Canadian Tertiary Center

Objective:
Hypoparathyroidism (HypoPT) is a rare endocrine disorder. If not managed optimally during pregnancy, it may result in maternal and fetal morbidity in the form of miscarriage, preterm delivery, fetal skeletal demineralization, fetal respiratory distress, and fetal death. 

Methods:
We, retrospectively reviewed 7 women with chronic HypoPT (both postsurgical and non-surgical) with a total of 16 pregnancies occurring between 2012 to 2022. Clinical and metabolic data as well as fetal and maternal outcomes for both groups are presented in the results. 

Results:
The rate of C-sections in pregnancies complicated by HypoPT was higher than that recorded for the Canadian population in 2019, 43.7% vs.29.9%, respectively. The rate of C-sections was higher in the postsurgical group (p=0.041). Women with nonsurgical HypoPT had a higher rate of preterm delivery compared to the postsurgical cohort, 71% vs. 22% (p=0.02). In fact, the overall rate of preterm delivery in the Canadian population in 2014 was 7.8%, and higher during the pandemic at 7.9%. Women with nonsurgical HypoPT had a higher rate of hospital admission due to hypocalcemia (28% vs. 11%). Preeclampsia affects an estimated 4.6% of pregnancies worldwide, and it affected nearly 13% of our cohort.

Discussion/Conclusion:
In our retrospective analysis of pregnancies complicated by chronic HypoPT, we document a high prevalence of neonatal and maternal morbidity despite close monitoring of serum calcium throughout pregnancy aiming for a normal serum corrected calcium.

All Women with HypoPT require close follow-up during pregnancy. Special attention should be given to women with nonsurgical HypoPT as complication rates were higher in this subgroup.