From the Research
Women with Congenital Adrenal Hyperplasia (CAH) during pregnancy require glucocorticoid replacement therapy, typically hydrocortisone (Cortef) at doses of 15-25 mg daily divided into 2-3 doses, as recommended by the most recent study 1. The goal of this therapy is to prevent adrenal crisis while minimizing fetal exposure to glucocorticoids. Some key points to consider in the management of CAH during pregnancy include:
- The need for stress dosing protocols, typically doubling or tripling the usual dose during illness, and receiving IV hydrocortisone 100 mg every 8 hours during labor and delivery 1.
- The importance of continuing mineralocorticoid replacement with fludrocortisone (Florinef) at 0.05-0.2 mg daily, if the patient was taking it pre-pregnancy, though requirements may decrease in pregnancy due to the progesterone-mediated antimineralocorticoid effect 1.
- Regular monitoring of blood pressure, electrolytes, plasma renin activity, and clinical symptoms is essential to adjust dosing appropriately 1.
- The potential for dose increases of 20-40% during the third trimester due to physiological changes in pregnancy 2.
- The preference for oral hydrocortisone over prednisone or dexamethasone because it doesn't cross the placenta as readily, minimizing fetal exposure 3.
Overall, the management of CAH during pregnancy requires careful consideration of the balance between preventing adrenal crisis and minimizing excessive glucocorticoid exposure, which could lead to gestational diabetes, hypertension, or excessive weight gain 1, 2, 3.