From the Research
Gonadotropin hormone replacement therapy is not typically needed for women with Congenital Adrenal Hyperplasia (CAH) during pregnancy. The primary concern in managing CAH during pregnancy is adjusting glucocorticoid therapy to prevent adrenal crisis while minimizing risks to the fetus. According to the most recent study 1, women with CAH should continue glucocorticoid therapy during pregnancy, usually with hydrocortisone at doses of 15-40 mg daily divided into 2-3 doses, adjusted based on clinical symptoms and hormone levels. Some women may also need fludrocortisone (typically 0.05-0.2 mg daily) if they have the salt-wasting form of CAH.
Key considerations in managing CAH during pregnancy include:
- Adjusting glucocorticoid doses by 20-40% in the later trimesters due to increased metabolism and the rising levels of estrogen and progesterone 1
- Regular monitoring of blood pressure, weight, symptoms of adrenal insufficiency, and occasionally plasma renin activity 1
- Providing adequate glucocorticoid coverage to prevent adrenal crisis while avoiding excessive doses that could affect fetal growth or maternal glucose tolerance 1
The fundamental issue in CAH is adrenal enzyme deficiency (most commonly 21-hydroxylase deficiency) leading to cortisol deficiency and androgen excess, not gonadotropin deficiency. Therefore, the focus should be on optimizing glucocorticoid therapy rather than gonadotropin hormone replacement. This approach is supported by the most recent and highest quality evidence 1, which prioritizes glucocorticoid management in the treatment of CAH during pregnancy.