Evidence map›Paper›PMID 40159596›Full record

ArticleBJOG : an international journal of obstetrics and gynaecology2025

Pregnancy Outcomes in Women With Primary Adrenal Insufficiency: Data From a Multicentre Cohort Study.

Matthew Cauldwell, Philip J Steer, Masato Ahsan, Amanda Ali, Shabana Ashiq, Rebecca Ashworth, Deena Basha, Hsu Chong, Gillian A Corbett, Fidelma Dunne and 27 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BJOG : an international journal of obstetrics and gynaecology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

37 authors.

Matthew CauldwellDepartment of Obstetrics, Maternal Medicine Service, St George's Hospital, London, UK.ORCID https://orcid.org/0000-0003-2366-3133
Philip J SteerAcademic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK.
Masato AhsanDepartment of Endocrinology, University Hospitals, Leicester, UK.
Amanda AliDepartment of Obstetrics, Kingston Hospital, London, UK.
Shabana AshiqDepartment of Obstetrics, Maternal Medicine Service, St George's Hospital, London, UK.
Rebecca AshworthDepartment of Obstetrics, Liverpool Women's Hospital, Liverpool, UK.
Deena BashaDepartment of Maternal Medicine, Epsom and St Helier Hospital, Carshalton, UK.
Hsu ChongAcademic Department of Obstetrics, Birmingham Women's and Children's NHS Foundation Trust, University of Birmingham, Birmingham, UK.
Gillian A CorbettUCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.ORCID https://orcid.org/0000-0003-0378-8297
Fidelma DunneDepartment of Diabetes Obesity and Endocrinology Galway University Hospital, Clinical Trial Network in Diabetes, Institute for Clinical Trials, University of Galway, Galway, Ireland.
Amanda HillMaternal Medicine Department, North Bristol NHS Trust, Bristol, UK.
Katarzyna Gajewska-KnapikRosie Maternity Unit, Department of Obstetrics, Addenbrookes Hospital, Cambridge, UK.
Adam JakesDepartment of Obstetrics, Kingston Hospital, London, UK.
David McLarenLeeds Centre for Diabetes and Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Therese KinsellaDepartment of Obstetrics, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Tara LeeDepartment of Obstetrics, Norfolk and Norwich University Hospitals, Norfolk, UK.
Miles LevyDepartment of Endocrinology, University Hospitals, Leicester, UK.
Lucy MacKiliopNuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
Fionnuala M McAuliffeUCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.ORCID https://orcid.org/0000-0002-3477-6494
Aarthi MohanDepartment of Obstetrics, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Clare MumbySt. Mary's Hospital, Manchester University Foundation Trust, Manchester, UK.
Melanie NanaGuy's and St Thomas' NHS Foundation Trust, London, UK.ORCID https://orcid.org/0000-0002-7908-8986
Catherine NapierDepartment of Endocrinology, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK.
Francesca NeubergerMaternal Medicine Department, North Bristol NHS Trust, Bristol, UK.
Christine NewmanDepartment of Diabetes Obesity and Endocrinology Galway University Hospital, Clinical Trial Network in Diabetes, Institute for Clinical Trials, University of Galway, Galway, Ireland.
Tabitha OosterhouseDepartment of Obstetrics, Ysbyty Gwynedd, Betsi Cadwaldar University Health Board, Saint Asaph, UK.
Amelia ShardNuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
Hassan ShehataDepartment of Maternal Medicine, Epsom and St Helier Hospital, Carshalton, UK.
Linden StockerDepartment of Obstetrics, University Hospitals Southampton, Southampton, UK.
Jeremy W TomlinsonDepartment of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Adele BeckDepartment of Endocrinology, Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter, UK.
Bijay VaidyaDepartment of Endocrinology, Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter, UK.
Kate WilesDepartment of Maternal Medicine, Barts Health NHS Trust, London, UK.
Catherine WilliamsonGuy's and St Thomas' NHS Foundation Trust, London, UK.ORCID https://orcid.org/0000-0002-6226-7611
Julia ZollnerDepartment of Obstetrics, University College Hospital, London, UK.
Emma WardLeeds Centre for Diabetes and Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Helen E TurnerDepartment of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo determine characteristics and pregnancy outcomes in women with primary adrenal insufficiency (PAI).

designRetrospective multicentre cohort study.

settingTwenty-three maternity units in the UK and Ireland. SAMPLE: Seventy-nine women with PAI who had 101 pregnancies.

methodRetrospective chart analysis.

main outcome measuresAdrenal crisis, pregnancy outcomes.

resultsWe obtained data on 101 pregnancies in 79 women with PAI. Most (51, 64.1%) had autoimmune disease, 8 (10.3%) had prior adrenal infarction/surgery/haemorrhage, 2 (2.6%) had congenital adrenal hyperplasia, and 18 (21.3%) were unclassified. 19 (24%) women experienced a crisis during pregnancy (18.8% of pregnancies). One woman died postpartum. Although all women had recorded endocrinology input during pregnancy, steroid emergency cards were only reportedly carried in 40 (39.6%) pregnancies and 9/19 (47.4%) of those with an adrenal crisis in pregnancy. Compared with the pre-pregnancy dose, only 41% of women received an increased hydrocortisone dose in pregnancy. The caesarean section rate was higher than the UK average: 62/97 (63.9%). The preterm birth rate was 21.2% (21/99) and 12.8% (12/94) of neonates had a birthweight < 10th centile.

conclusionWhilst the obstetric outcome of pregnancy with PAI is generally favourable, there are high rates of caesarean birth and prematurity. A high number of women experienced adrenal crisis and further exploration is warranted. Recommendations regarding third trimester increases in hydrocortisone need consideration and potentially strengthening, in light of further evidence. Pregnant women with adrenal insufficiency should carry an NHS steroid warning card; this should be reinforced both by endocrine and obstetric teams because of the increased risk of life-threatening adrenal crisis.

Indexed as

Addison DiseasePregnancy ComplicationsPregnancy OutcomeAdultCesarean SectionFemaleHumansHydrocortisoneInfant, NewbornIrelandPregnancyPremature BirthRetrospective StudiesUnited KingdomYoung AdultHydrocortisoneadrenal crisispregnancyprimary adrenal insufficiency

Identifiers

PMID40159596
PMCPMC12137789

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.