Individual research recommendation details

Recommendation ID

NG132/4

Question

What are the optimal management strategies for primary hyperparathyroidism during pregnancy?

Any explanatory notes
(if applicable)

Care before pregnancy

The committee noted that having surgery for primary hyperparathyroidism before becoming pregnant allows women to start their pregnancy with a normal serum calcium level, which reduces their risk of pregnancy-associated complications of primary hyperparathyroidism. They noted that the risk of stillbirth and neonatal tetany increases with a serum calcium level above 2.85 mmol/litre.

Care during pregnancy

Based on their experience, the committee agreed that management of primary hyperparathyroidism during pregnancy should be discussed with a multidisciplinary team (MDT) because of the high risk of maternal and neonatal complications.

The safety and efficacy of cinacalcet for pregnant women is largely unknown, so the committee agreed that cinacalcet should not be offered during pregnancy. They also agreed that bisphosphonates are potentially harmful for the mother and the fetus.

There was no evidence on monitoring for pregnant women. The committee agreed that monitoring should be guided by a specialist centre MDT because of the risk of maternal or fetal complications. They also highlighted primary hyperparathyroidism as a risk factor for pre‑eclampsia and hypertension.

There was little overall evidence on managing primary hyperparathyroidism during pregnancy so the committee made a research recommendation.

How the recommendations might affect practice

The recommendations made for women who are pregnant or considering pregnancy might change practice in some areas. However, this is a small population so they are not expected to have a substantial impact on practice.

Full details of the evidence and the committee's discussion are in evidence review J: pregnancy.

Source guidance details

Comes from guidance

Hyperparathyroidism (primary): diagnosis, assessment and initial management

Number

NG132

Date issued

May 2019

Other details