Management of Congenital Adrenal Hyperplasia During Pregnancy

The 2012 document reviewed the management of congenital adrenal hyperplasia (CAH) during pregnancy, highlighting that with improved strategies, women with CAH can have successful pregnancies. It noted that both men and women with CAH have reduced fertility, with women experiencing chronic anovulation and elevated progestin levels, and men facing issues like testicular adrenal rest tumors and oligospermia. The review stressed the importance of suppressing progesterone preconception and individualizing treatment, including glucocorticoid and mineralocorticoid therapies, to achieve healthy pregnancies. It also discussed the need for genetic counseling for CAH patients planning to have children, the use of glucocorticoids every 8 hours to prevent elevated progesterone, and careful management during pregnancy, labor, and delivery, including monitoring for gestational diabetes and considering Caesarean section. Additionally, it touched on the ethical concerns of prenatal dexamethasone treatment to prevent genital virilization in female infants with CAH. The conclusion was that with careful management, patients with CAH can become parents.