Pregnancy and delivery associated with Cushing’s disease

Aim. We evaluated retrospective cohort data from 22 patients whose pregnancy associated with proven Cushing’s Disease (CD) in order to estimate its consequences for mother and child.

Methods. The data was collected from individual patients referred to our department and from the personal contact with patients whose data was available through the Russian database. All subjects had medical records sufficient to confirm CD.

Results. The following complications during pregnancy were suggested to be more common: arterial hypertension (45%), uterus hypertonus (41%), miscarriage risk (36%), late preeclampsia (18%), gestational diabetes (14%), fetal hypoxia (14%), placental detachment (10%). The common complications during delivery were entanglement umbilical cord of the fetus (n=9 ), fetal hypoxia (n= 8), bleeding (n=6 ), arterial hypertension (n= 4),CNS depression syndrome (n= 4).

Women whose CD was manifested during or after the pregnancy had less complications as compared to women who had CD before pregnancy. The newly diagnosed during pregnancy or just after pregnancy patients with CD were more likely to achieve remission after the postpartum neurosurgery (100% of remission), as compared to women who suffered from CD before pregnancy (69% of remission). Moreover, the exacerbation of CD was registred after delivery (in 18 out of 22 subjects) and 50% (in 4 out of 8 subjects) recurrence rate in patients who were in remission before pregnancy.

The age of children (n=22 ) varied from 1 to 10 years, and 70% were practically healthy at the moment of examination. However, some children suffered from headache ( 27% or n = 6), dizziness (27% or n = 6) or expansion pyelocaliceal system (14% or n=3). The identified data seems to be not differed from the population. According to Russian database, 33% of children were born with health problems in 2014.

Conclusions. The complication rate in pregnancy rises with the activity of CD, but up to 70% of newborns are healthy and the existing health problems seems to be not specific. Up to 50% of patients with the history of CD might had the recurrences of the disease after the delivery. Consequently, pregnancy in CD should be prolonged, but careful examination must be recommended to all women with the history of CD after delivery.