Management and outcomes of primary aldosteronism in pregnancy: a systematic review

Sanga, V., Rossitto, G., Seccia, T. M. and Rossi, G. P. (2022) Management and outcomes of primary aldosteronism in pregnancy: a systematic review. Hypertension, 79(9), pp. 1912-1921. (doi: 10.1161/HYPERTENSIONAHA.121.18858) (PMID:35686552)

Abstract

Primary aldosteronism (PA) in pregnancy (PAP) can be a serious condition and is challenging to diagnose. This study was conceived to help in the diagnosis of PAP and provide suggestions on management of PAP based on evidence retrieved using a Population, Intervention, Comparison, and Outcome search strategy. Based on the changes of aldosterone and renin occurring in normal pregnancies, we developed a nomogram that will allow to identify PAP cases. Moreover, we found that published PAP cases fell into 4 main groups differing for management and outcomes: (1) unilateral medically treated, (2) unilateral surgically treated, (3) bilateral medically treated and iv) familial forms. Results showed that complications involved 62.2% of pregnant women with nonfamilial PA and 18.5% of those with familial hyperaldosteronism type I. Adrenalectomy during pregnancy in women with PAP did not improve maternal and fetal outcomes, over medical treatment alone. Moreover, cure of maternal hypertension and mother and baby outcome were better when unilateral PA was discovered and surgically treated before or after pregnancy. Therefore, fertile women with arterial hypertension should be screened for PA before pregnancy and, if necessary, subtyped to identify unilateral forms of PA. This will allow to furnish adequate counseling, a chance for surgical cure and, therefore, for a pregnancy not complicated by aldosterone excess.

• Item Type: Articles
• Keywords: Renin, adrenalectomy, hypertension, pregnancy, familial hyperaldosteronism.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Rossitto, Dr Giacomo
• Authors: Sanga, V., Rossitto, G., Seccia, T. M., and Rossi, G. P.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Hypertension
• Publisher: American Heart Association
• ISSN: 0194-911X
• ISSN (Online): 1524-4563
• Published Online: 10 June 2022
• Copyright Holders: Copyright © 2022 American Heart Association, Inc.
• First Published: First published in Hypertension 79(9): 1912-1921
• Publisher Policy: Reproduced in accordance with the publisher copyright policy