title: Growth hormone (GH) replacement therapy in GH-deficient women during pregnancy.
abstract: OBJECTIVE
  The present recommendation is to discontinue GH replacement therapy in hypopituitary women, as they become pregnant. We report our experience of managing GH deficiency with GH replacement therapy in pregnant hypopituitary women.
  
  
  METHODS
  Eight hypopituitary women, median age 30.5 years (range 20-39 years), were followed prospectively during 12 distinct pregnancies. Six women were receiving replacement therapy for other pituitary hormone deficiencies and five pregnancies were achieved with ovulation induction therapy. GH replacement therapy was maintained at the same pregestational dose during the first trimester, with a gradual decrease of the dose during the second trimester and discontinuing the treatment at the beginning of the third trimester. Serum IGF-1 levels were measured in four selected pregnancies at three different points, one in each trimester of gestation.
  
  
  RESULTS
  Seven pregnancies resulted in normal vaginal deliveries and five had programmed Caesarian sections. The median gestation age at time of delivery was 40 weeks (range 33-42 weeks). Newborns had a median birthweight SD score of -0.37 (range -1.93 to 1.21) and a median birthlength SD score of 0.07 (range -2.73 to 1.53). No congenital malformations were observed. Three women were able to breastfeed their babies. Before gestation, the median daily dose of GH was 0.5 mg (range 0.3-0.8 mg) and the median serum IGF-1 was 37.5 nmol/l (range 7.6-54.5 nmol/l). IGF-1 levels were fairly constant in the first and second trimesters of gestation, showing an increment during the last trimester, when GH treatment was discontinued.
  
  
  CONCLUSIONS
  The GH replacement regimen presented for pregnant women with GH deficiency was safe. No major side-effects and no negative influences on maternal and fetal outcome were observed.
authors.affiliation: RCEM Research Centre for Endocrinology and Metabolism, Sahlgrenska University Hospital, Göteborg, Sweden. lene.wiren@medic.gu.se
authors.forename: Lena
authors.initials: L
authors.lastname: Wirén
authors.forename: Cesar Luiz
authors.initials: CL
authors.lastname: Boguszewski
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Johannsson
mesh_terms: D000328:Adult; D001724:Birth Weight; D001827:Body Height; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D013006:Growth Hormone / Q000172:deficiency / Q000627:therapeutic use*; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy*; D007231:Infant, Newborn; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011264:Pregnancy Trimesters; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone