From the Research
Treatment of congenital adrenal hyperplasia (CAH) during pregnancy requires careful management with glucocorticoids to prevent virilization of a female fetus, and the most recent evidence suggests that glucocorticoid replacement regimens should be optimized for each individual patient. The management of CAH during pregnancy is complex and involves multiple considerations, including the prevention of adrenal crisis, the management of maternal and fetal risks, and the optimization of glucocorticoid replacement therapy 1. Some key points to consider in the management of CAH during pregnancy include:
- The use of glucocorticoids, such as hydrocortisone, to prevent adrenal crisis and manage maternal symptoms
- The adjustment of glucocorticoid doses during pregnancy, labor, and delivery to prevent adrenal crisis and ensure adequate fetal and maternal health
- The monitoring of maternal and fetal health, including blood pressure, glucose, and electrolyte levels, to prevent complications
- The consideration of prenatal testing and genetic counseling to determine the risk of transmitting CAH to the offspring
- The potential use of dexamethasone to prevent virilization of a female fetus, although this is still a topic of debate and the most recent evidence suggests that the benefits and risks of this approach should be carefully weighed for each individual patient 2, 3, 4, 5. The most effective approach to managing CAH during pregnancy will depend on the individual patient's needs and circumstances, and should be guided by the most recent and highest-quality evidence, as well as careful consideration of the potential benefits and risks of different treatment strategies. In terms of specific treatment recommendations, the evidence suggests that:
- Hydrocortisone is a commonly used glucocorticoid for the management of CAH during pregnancy, and is typically administered at a dose of 15-25 mg/day divided into 2-3 doses
- Dexamethasone may be considered for the prevention of virilization of a female fetus, although the benefits and risks of this approach should be carefully weighed for each individual patient
- Stress-dose steroids, such as hydrocortisone 100 mg IV every 8 hours, may be necessary during labor and delivery to prevent adrenal crisis
- Regular monitoring of maternal and fetal health, including blood pressure, glucose, and electrolyte levels, is essential to prevent complications and ensure optimal outcomes.