Changes in Serum Calcium and Treatment of Hypoparathyroidism During Pregnancy and Lactation: A Single-center Case Series

Abstract

Background: Hypoparathyroidism (hypo-PT) is rare, and studies on hypo-PT, especially during pregnancy and lactation, are limited.

Design and setting: This was a retrospective study on a relatively large case series in a single center from mainland China.

Methods: A total of 19 patients with 25 pregnancies, diagnosed with hypo-PT before pregnancy, were enrolled. Data on clinical characteristics and treatment strategies at onset time and around pregnancy period were collected.

Results: During pregnancy, except for 2 patients with missing data, 5 patients with 6 pregnancies (6/23, 26.1%) experienced improved hypo-PT condition, defined as an increased serum calcium level; 4 patients with 4 pregnancies (4/23, 17.4%) experienced worsened hypo-PT condition, defined as a more than 0.2 mmol/L decline in the serum calcium level; and 3 patients with 3 pregnancies (3/23, 13.0%) remained in stable hypo-PT condition. The prevalence of adverse pregnancy outcomes was 30.4% (4/23 for preterm delivery; 3/23 for miscarriage). The serum calcium and 24-hour urine calcium levels significantly increased during lactation compared with pregnancy (2.57 ± 0.34 vs 1.99 ± 0.11 mmol/L, P < 0.001; 12.28 ± 5.41 vs 8.63 ± 3.22 mmol/L, P = 0.013), and 5 patients with 5 lactations (5/12, 41.7%) developed hypercalcemia in the first 2 months after delivery.

Conclusions: Female patients with hypo-PT had different changes in calcium homeostasis and a high prevalence of adverse outcomes during pregnancy. Thus, they should be monitored closely to maintain the optimal serum calcium level. Decreasing drug dosage during the lactation period should be considered to avoid hypercalcemia.

Keywords: hypoparathyroidism; lactation; pregnancy; serum calcium; treatment.