pregnancy, pregnancy, pregnant, pregnant woman,
pregnancy, parathyroid pregnant.
Parathyroid
disease (hyperparathyroidism) is not common and it usually affects people
in their 50's and 60s and 70s... but some young people DO get
hyperparathyroidism (see our graph of patient's ages
on another page). Treating parathyroid disease almost always involves elective surgery that
can be scheduled weeks or even months ahead of time. One of the few
times when parathyroid disease is dangerous and requires expert care and
thoughtful preparation is during pregnancy. The pregnant female is at
risk for significant pregnancy problems and complications, but more
importantly, the life of the baby is at risk. Furthermore, even a 'normal'
pregnancy and delivery do not eliminate the the baby's risk for
development problems within their endocrine system -- because of the
mother's high calcium levels. Lets look at some of these problems
individually.
The Risk of Miscarriage
The
data about miscarriage (loss of the fetus) in women with
hyperparathyroidism (parathyroid disease) comes from the medical
literature and from our leading experience in this field. The bottom line,
there is a dramatic risk for miscarriage in a mother with
hyperparathyroidism. Well over half of all babies will be lost if the
mother's parathyroid tumor is not removed. Importantly, the risk is
directly related to the
calcium level in the mother. Mothers with a very high calcium level (above
12.0 mg/dl) have the highest risk of fetal demise and death. Our recent
study (by far the largest in the world) shows that the risk of fetal death
is over 50% in women
with calcium levels above 11.5, and as high as 85% when the calcium levels
get near 13. This graph shows how the risk of pregnancy loss (miscarriage)
increases as the mom's blood calcium increases.
In our most recent study, two thirds of women who were diagnosed with
hyperparathyroidism during pregnancy had one or more miscarriages in the
past several years. Some women had lost 4 babies during the first or
second trimester of pregnancy and no doctor realized that the problem was
the mother's calcium level. 100% of these ladies had successful
pregnancies (no miscarriages) after the parathyroid tumor was removed.
The reasons for fetal death in mothers with hyperparathyroidism is not
completely clear, but it is believed that the primary problem is with maternal blood pressure and its effect
on the placenta's blood flow.
There should be no doubt that having hyperparathyroidism during
pregnancy poses a dramatic threat to the life of the baby (and mother).
Ideally, the parathyroid tumor should be removed during the early part of
the second trimester by a very experienced surgeon in a very rapid
fashion. The average time of this operation in our last 15 pregnant
females was 18.6 minutes and was done between weeks 13 and 17. When done
in this fashion (as discussed below), it should be very safe for mom and
baby, and clearly a MUCH better option than doing nothing and hoping that
the baby survives.
|
Click
here to read the journal abstract of our recent publication on
this topic, the world's largest series of pregnant females with
parathyroid disease (hyperparathyroidism) and high calcium.
Clinical Endocrinology: 2009;Volume 71 Issue 1, Pages 104 - 109 |
Read
our Blog...
We publish interesting stories about hyperparathyroidism twice a week. One
of them is on high
blood calcium during pregnancy.
The Risk of Permanent Hyp0parathyroidism in the Baby
Hyp0parathyroidism
is the OPPOSITE of hypERparathyroidism. Nearly all of this large
web site is about hyperparathyroidism. There is only one page of this web
site dedicated to hyp0parathyroidism...
click hear to read more. When a person has no parathyroid glands and
thus no parathyroid hormone (PTH), then they are said to have
hyp0parathyroidism. Since PTH is absolutely required to maintain the
calcium in our bodies, people with hyp0parathyroidism have difficulty with
calcium metabolism. In fact, these people are required to take large
amounts of calcium pills every day of their life, and possibly have a shot of PTH under the skin every day just as a diabetic takes
insulin (insulin is a hormone just like PTH -- Insulin runs the blood sugar,
PTH runs the calcium).
NORMAL parathyroid glands have a built-in regulatory system... they
respond to calcium levels in the blood. When the calcium is low, normal
parathyroid glands make PTH. When the calcium is high, normal parathyroid
glands shut down and become dormant. This is the danger in the baby!
If a pregnant woman has high blood calcium due to hyperparathyroidism,
then the high calcium will be found in exactly the same way in the baby.
So a pregnant female with a calcium of 12.0 will have a fetus with a
calcium of 12.0. Since the parathyroid glands are formed some time
during the second and early third trimester, they can be affected by the
high calcium. If the calcium level is high, the parathyroid glands
that are supposed to be forming can be shut down just as they are supposed
to be growing into normal glands. Sometimes, they can be so
suppressed that they don't form at all and the baby is born without
functional parathyroid glands. If this is the case, the baby will need
HIGH doses of calcium in the nursery during the first few days of life,
and possibly for life. Again, just as the risk of miscarriage goes
up with higher levels of calcium, so does the risk of hyp0parathyroidism
in the baby. Note... not all baby's that have signs of hyp0parathyroidism
(very low calcium levels) during their first few days of life will have permanent
hyp0parathyroidism. Most will have it temporarily and will be fine once
they are given enough calcium early on... and their parathyroid glands
have a chance to wake up and perform normally.
Another problem for baby's born to mothers with hyperparathyroidism is
that these babies can be born with weak bones (almost like osteoporosis).
This is because they have been exposed to mom's high calcium which suppresses
their parathyroid glands (as discussed above), and because they are
exposed to mom's high PTH levels which takes calcium out of their forming
bones. Thus, babies born to mothers with hyperparathyroidism are at higher
risk of fractures during their early months/years until their parathyroid
glands become normal and the their bones begin to calcify better. Think of
it this way... the baby's are born with bones that are 9 months behind...
they haven't had a chance to calcify and become hard. This is another
reason why parathyroid tumors should be removed from the mothers during
the second trimester so the bones have a chance at getting hard during the
3rd trimester.
Risk of Seizures in the Baby During First Few Days of
Life
Throughout
this web site we discuss the importance of calcium in the function of the
human nervous system. Calcium is what makes our brain and nerves function
(and muscles)... thus most of the symptoms of parathyroid disease can be
traced back to the need for the nervous system to have calcium levels in a
very tightly controlled normal range. Outside this range (8.5 to 10.2) we
get symptoms -- with the symptoms of high calcium being the symptoms
of hyperparathyroidism, while the symptoms of a low calcium being the
symptoms of hyp0parathyroidism. When the calcium levels in the blood get
very low (below 8), we can have seizures.
When a baby is born to a mother with hyperparathyroidism, the baby's
parathyroid glands can be under-developed (as discussed above). But, even
if the baby's parathyroid glands developed normally, they will be
shut-down (suppressed) because that is what normal parathyroid glands do
in the presence of high calcium. So, when this baby is born, they
will have a high calcium (just like their mother), but over the next 24
hours their calcium will drop -- and continue to drop until their
parathyroid glands wake up and start producing PTH. If the calcium goes to
low during this time and the doctors are not monitoring it, the baby can
have seizures. The treatment is straightforward -- give the baby some
calcium into his/her veins to increase the blood calcium levels.
When to Operate on a Pregnant Woman with
Hyperparathyroidism
The
medical literature is fairly consistent in recommending that the mother be
operated on during the early part of the second trimester. The reasons
are several. First, operating during the first trimester can be too
dangerous for the baby -- the risk of complications due to the anesthesia
and/or the surgery is less in the second and third trimester. Secondly,
the parathyroids will be forming in the baby during the second and third
trimesters, so to avoid the potential of the baby NOT developing his/her
parathyroid gland the high calcium levels in the mother need to be
removed. Thirdly, high calcium levels during the third trimester are
associated with the development of high blood pressure and other
complications in the mother (pre-eclampsia and eclampsia).
Thus, hyperparathyroidism in a pregnant female should almost always be
fixed. And, this should be done with a minimally - invasive procedure that
is as quick as possible, and of course, has a high likelihood of cure. It
should be performed in the early part of the second trimester, and it
should be performed by an expert parathyroid surgeon. Typically, an obstetrician
specializing in high-risk OB should be involved in the care of the mother
and baby during this time and during the rest of the pregnancy.
In
2009 we published the world's largest series of pregnant females with
hyperparathyroidism. Click Here to read the abstract: Clinical
Endocrinology:
2009:71;104-109.
Unbelievable Stories of Failed Pregnancies and
Beautiful Babies:
