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Congenital adrenal hyperplasia (CAH) is a group of genetic disorders that affect the adrenal glands, leading to an imbalance in hormone production. Women with CAH often face unique challenges when it comes to fertility and pregnancy. They can face obstacles that women without the disease do not. Understanding these barriers is an important part of health. Whether you are looking to become pregnant, or wondering how the condition may affect your child, this overview should give a straightforward explanation. This resource is meant to offer guidance to women with CAH who are trying to conceive or during their pregnancy.
CAH and Fertility
CAH affects the adrenal glands, which are responsible for producing important hormones like cortisol, aldosterone, and androgens. There are different forms of CAH, with the most common being 21-hydroxylase deficiency. Women with CAH can have varying degrees of symptoms, from mild to severe, depending on the type of CAH they have.
Hormonal Imbalance and Fertility Issues
CAH can cause an imbalance in hormone production, leading to excess androgens. High levels of these hormones can disrupt the menstrual cycle, making it harder for women to ovulate regularly. Because of this, women with CAH may face difficulties in getting pregnant. However, with proper treatment, many women can restore their menstrual cycle and improve their chances of conceiving.
Hormonal Imbalance and Fertility Issues
Some women with CAH may have anatomical differences in their reproductive organs due to exposure to high levels of androgens in the womb. This can sometimes make sexual intercourse uncomfortable or difficult, further complicating efforts to conceive. Women with CAH may develop a condition like polycystic ovary syndrome (PCOS), which can also affect fertility. However, not all women with CAH develop PCOS.
Challenges During Pregnancy
For women with CAH, pregnancy can bring additional challenges, but with careful management, healthy pregnancies are possible.
Risk of Complications
Studies have shown that women with CAH may have a higher risk of certain pregnancy complications, such as gestational diabetes, preterm labor, and the need for cesarean delivery. There may also be a higher chance of having a baby who is small for their gestational age, especially in cases of more severe forms of CAH.
Managing Hormone Levels
During pregnancy, hormone levels naturally change. For women with CAH, it is important to carefully manage the condition to avoid complications. Women with CAH typically need to continue taking glucocorticoid medications, like hydrocortisone, to help balance hormone levels. However, the dosage may need to be adjusted throughout the pregnancy. Women with CAH might also need further support during labor and delivery. This could mean increased doses of glucocorticoids to help manage stress during childbirth. After delivery, the medication doses are gradually reduced to pre-pregnancy levels.
The hypothalamic-pituitary-adrenal axis? Low cortisol? High androgens? What does it all mean?
Watch now: The science behind CAH: What’s going on in my body?
Congenital adrenal hyperplasia (CAH) can be overwhelming, but breaking it down can make it easier to understand what's happening in your body. Hormones monitored by your doctor are produced by several different organs that make up the HPA axis. The HPA axis is short for hypothalamic-pituitary-adrenal axis and in people with CAH, those organs don’t work together as they should. Learn more about the HPA axis and its role in this video.
Questions about CAH and how it affects the body? Visit WhatTheCAH to learn more. Sponsored by Neurocrine Biosciences, Inc.
Planning for Pregnancy
Before trying to conceive, women with CAH should seek out education and counseling. They should be aware of the potential risks of passing CAH to their children. CAH is an autosomal recessive condition. This means that both parents need to carry the gene for the child to be affected. Genetic counseling can help prospective parents understand their risk and the steps they can take to manage it.
Planned pregnancies are especially important for women with CAH because it allows for proper medical management and genetic testing. Unplanned pregnancies may lead to missed opportunities for early intervention. Early genetic testing of the fetus can determine whether the baby has inherited CAH and what steps need to be taken during pregnancy.
Treatment and Management
Managing CAH during pregnancy requires a team approach involving endocrinologists, obstetricians, and sometimes genetic counselors. The goal is to maintain hormone levels that are safe for both the mother and the baby. In some cases, additional medications may be needed to manage symptoms or complications that arise during pregnancy. Regular monitoring of hormone levels and fetal development is also needed. This might include more frequent doctor visits and specialized tests.
Life After Pregnancy
After giving birth, women with CAH need to continue managing their condition carefully. Breastfeeding is generally recommended for women with CAH. However, it’s important to coordinate with healthcare providers to ensure that medication levels are safe for the baby. Women with CAH should continue regular follow-ups with their healthcare team to manage their condition and prevent complications. Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can help improve overall well-being and reduce the risk of complications.
Women with CAH face unique challenges when it comes to fertility and pregnancy. With proper management, many can have successful pregnancies and healthy outcomes. It is important to work closely with your doctors to navigate CAH. Through education, planning, and ongoing support, women with CAH can enjoy fulfilling and healthy pregnancies.