Thyroid disorders and other endocrine disorders in pregnancy

The number of women with endocrine conditions embarking on pregnancy is growing as more choose to delay conception or require assisted reproduction techniques. It is therefore increasingly important for clinicians to have an understanding of common endocrine disorders and how these may impact on pregnancy and fetal development. Over-investigation and subsequent medicalization and treatment of sub-clinical endocrine conditions, which have uncertain clinical impact for the fetus or mother, is a cause for concern and debate surrounding this practice is ongoing. Vitamin D deficiency is increasing in prominence due to the rise in childhood rickets; this startling re-emergence has led to more work on the prevalence of vitamin D deficiency and identified a higher than expected percentage of women affected. For this reason, national advice has called for routine vitamin D supplementation in pregnancy, and diagnosis and treatment of those most at risk. This review also briefly discusses the management of other rarer endocrine conditions, which can lead to significant maternal and fetal morbidity if the diagnosis is delayed or overlooked.