Pregnancy is a beautiful journey, but it can also bring about significant changes in a woman’s body, particularly in hormonal balance. For some expectant mothers, these changes may lead to endocrine disorders, which require careful management to ensure a healthy pregnancy. In this insightful interview, Dr. Vikram Sonawane, Senior Consultant Endocrinologist and Founder of Harmony Thyroid Endocrinology and Diabetes Centre, shares his expertise on the most common endocrine disorders during pregnancy, the impact of maternal age, and the importance of preconception care. Join us as Dr. Sonawane sheds light on how to detect, treat, and manage these disorders, offering valuable advice to help mothers navigate pregnancy with confidence and care.

Q: What are the common endocrine disorders during pregnancy?
The most common endocrine disorders during pregnancy include gestational diabetes and thyroid disorders. Gestational diabetes affects approximately one in five pregnancies globally, with Singapore reporting similar trends due to rising obesity and lifestyle changes.

Fortunately, the incidence of new autoimmune endocrine conditions does not occur during pregnancy. However, pre-existing hypothyroidism or hyperthyroidism is very common in young women in the reproductive age group. The thyroid hormone plays a crucial role in the fetus’s development and significantly impacts the course of pregnancy, including delivery.

Q: Are endocrine disorders more prevalent in women of higher or advanced maternal age (35 and above)?
Yes, endocrine disorders are generally more prevalent in women of advanced maternal age (35 and above). For instance, gestational diabetes and thyroid disorders are more frequently seen in this age group due to the increase in the resistance to insulin and metabolic changes associated with aging. Studies show that women over 35 have a two to four times higher risk of developing gestational diabetes than younger women.

Advanced maternal age is also linked to higher rates of infertility and complications like PCOS, which can exacerbate hormonal imbalances and lead to endocrine challenges during pregnancy.

Q: How can preconception care contribute to preventing endocrine disorders during pregnancy?
Preconception care plays a crucial role in identifying and managing potential endocrine disorders before pregnancy. By evaluating a woman’s health, including her thyroid function, glucose levels and other hormonal markers, healthcare providers can offer interventions that reduce the risk of complications. For instance, addressing subclinical hypothyroidism before conception can prevent adverse pregnancy outcomes like preterm birth and miscarriage.

Additionally, women with known conditions like PCOS or prediabetes can benefit from lifestyle changes, medication adjustments, and regular monitoring to minimise the risk of developing more severe endocrine disorders during pregnancy.

Q: What types of hormonal changes during pregnancy require medical intervention?
Pregnancy naturally brings about significant hormonal changes, but in very few instances, it requires medical intervention to prevent complications. Thyroid hormone excess, also called hyperthyroidism, needs to be addressed promptly, as untreated thyroid disorders can lead to pre-eclampsia, low birth weight, and developmental issues in the baby.

Gestational thyrotoxicosis is another condition where hyperthyroidism is mainly caused by the high pregnancy-related hormone (beta-HCG) and does not require any treatment.

A known hypothyroidism patient requires dose increments as high as 30% during pregnancy.

Excessive insulin resistance, seen in gestational diabetes, also demands medical attention. Uncontrolled gestational diabetes can increase the risk of macrosomia (having a large baby), birth complications, and future type-2 diabetes for both mother and child.

Q: Can patients recover from endocrine disorders after childbirth?
Yes, many women recover from pregnancy-related endocrine disorders after childbirth. For example, gestational diabetes often resolves after delivery, though women remain at higher risk for developing type 2 diabetes later in life (up to 50% within ten years). Postpartum thyroiditis, a temporary thyroid inflammation, may also occur but usually resolves within a year. However, for some women, conditions like hypothyroidism or type 2 diabetes may persist, requiring long-term management.

Q: What are the long-term effects of pregnancy-related endocrine disorders on women’s health?
Pregnancy-related endocrine disorders can have long-term implications for a woman’s health. Women who experience gestational diabetes, for instance, have a seven-fold increased risk of developing type 2 diabetes in the future. Thyroid disorders, if left unmanaged, can lead to long-term issues such as chronic fatigue, weight gain, and fertility problems.
In addition, metabolic and cardiovascular diseases may arise later in life, especially for those who experienced preeclampsia, gestational diabetes, or insulin resistance during pregnancy. Long-term monitoring and lifestyle interventions are often necessary to mitigate these risks.

Q: How early in pregnancy can endocrine disorders be detected?
Endocrine disorders can often be detected in the first trimester or even earlier with preconception care. For instance, gestational diabetes is typically screened for between 24 and 28 weeks, but women with high-risk factors may undergo testing earlier. Thyroid dysfunction can be detected early through routine blood tests in the first trimester, as these conditions can significantly affect fetal development if left unmanaged.

For women with pre-existing conditions like PCOS or diabetes, continuous monitoring before and during pregnancy allows for early detection and intervention of any worsening hormonal imbalances.

Certain endocrine conditions cause infertility, for example, hyperprolactinemia (prolactin hormone is responsible for producing milk after delivery), high or low thyroid hormone levels, adrenal hormone excess, etc.

Q: What are the treatment options for managing endocrine disorders during pregnancy?
Treatment for endocrine disorders during pregnancy involves a combination of medications, lifestyle modifications, and regular monitoring. For gestational diabetes, treatment may include dietary changes, exercise, and insulin therapy if necessary. Thyroid disorders are usually managed with levothyroxine for hypothyroidism or anti-thyroid medications for hyperthyroidism, with regular thyroid function tests to adjust dosages.

Women with adrenal disorders or other rare conditions may require specialised hormonal therapies, and close collaboration with an endocrinologist is essential to ensure safe outcomes for both mother and baby.

Q: Are there specific lifestyle changes recommended for women with endocrine disorders during pregnancy?
Yes, dietary adjustments and physical activity are key lifestyle changes for managing endocrine disorders during pregnancy. For women with gestational diabetes or insulin resistance, following a low-glycemic index diet can help regulate blood sugar levels. Regular, moderate exercise can also improve insulin sensitivity and support overall health.
Additionally, depending on their condition, women with thyroid conditions should avoid foods that interfere with thyroid function, such as excessive soy and iodine-rich foods. Stress management, adequate sleep, and frequent medical check-ups are essential components of care during pregnancy.

Images: Shutterstock, EHC and Harmony Thyroid Endocrinology and Diabetes Centre