Dr Paula Jacobson1, Dr Naomi Smith1, Dr Madeleine Elder2, Dr Alice Burton1, Dr Rajit Narayan1
1Department of Women and Babies, Royal Prince Alfred Hospital, Camperdown, Australia, 2Department of Obstetrics and Gynaecology, St George Hospital, Kogarah, Australia
Biography:
Dr. Paula Jacobson is a junior doctor in Obstetrics and Gynaecology based at RPA Hospital in Sydney, with an interest in complex pregnancies and Maternal-Fetal Medicine.
Abstract:
Hypercalcaemia in pregnancy is a rare diagnosis which can cause maternal, fetal and neonatal morbidity and mortality. Complications include hypertension, preeclampsia, renal impairment, nephrolithiasis, pancreatitis, depression, fetal growth restriction and neonatal hypocalcaemia. Causes include primary hyperparathyroidism, placental parathyroid hormone-related protein (PTHrP), abnormal vitamin D metabolism, familial hypocalciuric hypercalcaemia and malignancy. Screening for hypercalcaemia is not routine practice in Australia, and the nonspecific symptoms (including nausea and vomiting, fatigue, mood change, arthralgia, constipation, polyuria and thirst) may be difficult to distinguish from physiological changes of pregnancy. There is a paucity of literature to describe this phenomenon, its prevalence and implications.
We present a case series of ten women with hypercalcemia during pregnancy at a tertiary hospital. To our knowledge, this is the largest case series on the subject. Of these women, three cases were attributed to PTHrP, three to primary hyperparathyroidism, one to familial hypocalciuric hypercalcaemia, and three to a combination of PTHrP and other factors (including diabetic ketoacidosis, sarcoidosis and primary hyperparathyroidism). Three women required parathyroidectomy in the second trimester, five women were managed with inpatient intravenous fluid replacement, and two were managed with targets of two to three litres of oral fluid intake daily. Other treatments included diuretics and subcutaneous calcitonin. Half of the women had no adverse maternal or neonatal outcomes. Two women had intrauterine growth restriction, and three women had pre-eclampsia requiring emergency caesarean sections; one of whom also had post-natal depression.
Though rare, hypercalcaemia in pregnancy can have serious ramifications for both mother and fetus. This case series reveals a high rate of intervention and adverse outcomes in association with hypercalcaemia. Prospective evaluation of calcium levels in unselected patients may better define the scope of hypercalcaemia in pregnancy.
Keywords
hypercalcaemia, pre-eclampsia, intrauterine growth restriction,
References
1. Appelman-Dijkstra NM, Ertl DA, Zillikens MC, Rjenmark L, Winter EM. Hypercalcemia during pregnancy: management and outcomes for mother and child. Endocrine. 2021 Feb 5;71(3):604–10
2. Dandurand K, Ali DS, Khan AA. Hypercalcemia in Pregnancy. Endocrinology and Metabolism Clinics of North America. 2021 Dec;50(4):753–68
3. Rey E, Jacob C, Koolian M, Morin F. Hypercalcemia in pregnancy – a multifaceted challenge: case reports and literature review. Clinical Case Reports [Internet]. 2016 Sep 17 [cited 2024 Apr 28];4(10):1001–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5054480/#:~:text =Hypercalcemia %20in%20pregnancy%20is%20an