{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T00:47:35Z","timestamp":1769302055641,"version":"3.49.0"},"reference-count":22,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T00:00:00Z","timestamp":1743292800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine characteristics and pregnancy outcomes in women with primary adrenal insufficiency (PAI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective multicentre cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Twenty\u2010three maternity units in the UK and Ireland.<\/jats:p><\/jats:sec><jats:sec><jats:title>Sample<\/jats:title><jats:p>Seventy\u2010nine women with PAI who had 101 pregnancies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Retrospective chart analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Adrenal crisis, pregnancy outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We 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\u2010pregnancy 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 &lt;\u200910th centile.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Whilst 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\u2010threatening adrenal crisis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.18143","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T01:00:11Z","timestamp":1743469211000},"page":"1122-1129","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Pregnancy Outcomes in Women With Primary Adrenal Insufficiency: Data From a Multicentre Cohort Study"],"prefix":"10.1111","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2366-3133","authenticated-orcid":false,"given":"Matthew","family":"Cauldwell","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Maternal Medicine Service St George's Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip J.","family":"Steer","sequence":"additional","affiliation":[{"name":"Academic Department of Obstetrics and Gynaecology Chelsea and Westminster Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masato","family":"Ahsan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology University Hospitals  Leicester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Kingston Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shabana","family":"Ashiq","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Maternal Medicine Service St George's Hospital  London 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Maternity Hospital  Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fidelma","family":"Dunne","sequence":"additional","affiliation":[{"name":"Department of Diabetes Obesity and Endocrinology Galway University Hospital, Clinical Trial Network in Diabetes, Institute for Clinical Trials University of Galway  Galway Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Hill","sequence":"additional","affiliation":[{"name":"Maternal Medicine Department North Bristol NHS Trust  Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katarzyna","family":"Gajewska\u2010Knapik","sequence":"additional","affiliation":[{"name":"Rosie Maternity Unit, Department of Obstetrics Addenbrookes Hospital  Cambridge UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Jakes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Kingston Hospital  London 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