title: Management of hypoparathyroidism in pregnancy and lactation - A report of 10 cases.
abstract: BACKGROUND
  Hypoparathyroidism in pregnancy is rare, but important, as it is associated with maternal morbidity and foetal loss. There are limited case reports and no established management guidelines. Optimal maintenance of calcium levels during pregnancy is required to minimise the risk of related complications. This study aims to identify causes and examine outcomes of hypoparathyroidism in pregnancy in a cohort of women delivering at a large referral centre.
  
  
  METHODS
  The Monash Health maternity service database captures pregnancy and birthing outcomes in over 9000 women each year. We audited this database between 2000 and 2014 to examine the clinical course, treatment and outcomes of pregnant women with hypoparathyroidism.
  
  
  RESULTS
  We identified 10 pregnancies from 6 women with pre-existing hypoparathyroidism secondary to idiopathic hypoparathyroidism (n = 3), autosomal dominant branchial arch disorder with hypoparathyroidism (n = 3) and autosomal dominant hypocalcaemia (n = 1), surgery for thyroid cancer (n = 2) and Graves' disease (n = 1). Maternal calcium levels were monitored through pregnancy and management adjusted to maintain normocalcaemia. One woman was delivered by caesarean section at 34 weeks' gestation because of intrauterine growth restriction, and oligohydramnios complicated two other pregnancies. The postpartum period was complicated by severe hypercalcaemia in one woman and by symptomatic, labile serum calcium levels during lactation in another woman, requiring close monitoring over a 6 month period.
  
  
  CONCLUSIONS
  Although rare, hypoparathyroidism in pregnancy poses a management challenge for clinicians, and co-ordinated care is required by obstetricians and endocrinologists to ensure optimal outcomes for both mother and baby. Continued monitoring of maternal calcium levels during lactation and weaning is essential to avoid the potential complications of either hypercalcaemia or hypocalcaemia.
authors.affiliation: Department of Endocrinology, Monash Health, 246 Clayton Road, Clayton 3168 Victoria, Australia; Departments of Medicine and Obstetrics & Gynaecology, Monash University, Australia.
authors.forename: B L
authors.initials: BL
authors.lastname: Hatswell
authors.affiliation: Department of Endocrinology, Monash Health, 246 Clayton Road, Clayton 3168 Victoria, Australia; Departments of Medicine and Obstetrics & Gynaecology, Monash University, Australia; Hudson Institute of Medical Research, 27-31 Wright Street, Clayton 3168 Victoria, Australia.
authors.forename: C A
authors.initials: CA
authors.lastname: Allan
authors.affiliation: Department of Endocrinology, Monash Health, 246 Clayton Road, Clayton 3168 Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Teng
authors.affiliation: Department of Endocrinology, Monash Health, 246 Clayton Road, Clayton 3168 Victoria, Australia; Departments of Medicine and Obstetrics & Gynaecology, Monash University, Australia; Hudson Institute of Medical Research, 27-31 Wright Street, Clayton 3168 Victoria, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Wong
authors.affiliation: Department of Endocrinology, Monash Health, 246 Clayton Road, Clayton 3168 Victoria, Australia; Departments of Medicine and Obstetrics & Gynaecology, Monash University, Australia.
authors.forename: P R
authors.initials: PR
authors.lastname: Ebeling
authors.affiliation: Departments of Medicine and Obstetrics & Gynaecology, Monash University, Australia; Hudson Institute of Medical Research, 27-31 Wright Street, Clayton 3168 Victoria, Australia.
authors.forename: E M
authors.initials: EM
authors.lastname: Wallace
authors.affiliation: Department of Endocrinology, Monash Health, 246 Clayton Road, Clayton 3168 Victoria, Australia; Departments of Medicine and Obstetrics & Gynaecology, Monash University, Australia; Hudson Institute of Medical Research, 27-31 Wright Street, Clayton 3168 Victoria, Australia.
authors.forename: P J
authors.initials: PJ
authors.lastname: Fuller
authors.affiliation: Department of Endocrinology, Monash Health, 246 Clayton Road, Clayton 3168 Victoria, Australia; Departments of Medicine and Obstetrics & Gynaecology, Monash University, Australia; Hudson Institute of Medical Research, 27-31 Wright Street, Clayton 3168 Victoria, Australia.
authors.forename: F
authors.initials: F
authors.lastname: Milat
keywords: Bone; Calcium; Hypoparathyroidism; Pregnancy