Reproductive outcome of a patient with congenital adrenal hyperplasia: case report

Abstract

Congenital Adrenal Hyperplasia are a group of inherited autosomal recessive enzymatic defects of adrenal steroid biosynthesis. Low pregnancy rate has been reported in women with CAH. Several factors have been suggested to contribute to this subfertility such as androgen excess, adrenal progesterone hyper secretion, consequences of genital reconstructive surgery, secondary PCOS and psychosexual factors. In contrast to this subfertility, pregnancies are normal and uneventful. During pregnancy, maternal & fetal problems are confined to these deficiencies. Adequate glucocorticoid therapy and improvement of surgical and psychological management could contribute to optimize fertility in CAH. The interposition of the placenta on the HPA axis & other endocrine changes during pregnancy impact considerably on the clinical evaluation of CAH. A 21 years old Primigravida presented to us at 13 weeks of gestation with history of CAH on treatment and vaginoplasty done in the childhood. Endocrinologist opinion was taken, and steroids continued. Advised to meet genetist and follow up for prenatal testing. But patient denied. Antenatal period was uneventful. Patient underwent Emergency LSCS in view of CPD in labour at 36+6 weeks of gestation. Pre-op stress dose of steroid given. A girl baby of birth weight 2.13 kg was born with good Apgar scores. Perioperative period uneventful. Preconception health, including hormonal, psychosexual and anatomical barriers to fertility should be addressed early in women with CAH. This review provides fertility outcome and pregnancy issues of a woman with CAH.