Abstract
Autoimmune adrenalitis (AA) and congenital adrenal hyperplasia (CAH) are the most
common reasons for acquired and monogenetic primary adrenal insufficiency. Both concern
women in their fertile years. The aim of the work was to examine fertility rates,
pregnancy outcome, and children’s characteristics in AA and CAH patients in 2 German
endocrine centers. One hundred and fifty-eight women were contacted. Thirty-nine patients
with CAH due to 21-hydroxlase deficiency and 54 AA patients agreed and were included.
Information about course and outcome of pregnancies was obtained by questionnaire
and telephone interview. Fertility rates were calculated and compared to expected
values from the German general population. Twelve CAH patients (30.8%) had 25 pregnancies,
which resulted in 16 children. In AA patients, 93 pregnancies in 42 women (75%) were
reported resulting in 73 childbirths. Fertility rates were normal in nonclassic CAH
and in AA-only patients, but significantly reduced in classic CAH and autoimmune polyendocrine
syndrome type 2 (APS-2). Rates of miscarriages were high in all CAH (36%) and APS-2
(22%) patients. The majority of children in both groups were born at term, but rates
of cesarean section were elevated in classic CAH and in AA patients<5 years before
or after diagnosis. Children born to CAH patients weighed significantly less than
expected and 33.3% of them were born small for gestational age. Fertility seems not
to be reduced in general, but specific in classic CAH and APS 2 patients. Nevertheless
all CAH and AA patients seem to be at risk of miscarriages and cesarean section.
Key words
congenital adrenal hyperplasia - APS - cesarean section - miscarriage
