Hypercalcemia during pregnancy: management and outcomes for mother and child

Abstract

Diagnosing and treating hypercalcemia during pregnancy can be challenging due to both the physiological changes in calcium homeostasis and the underlying cause for the hypercalcemia. During pregnancy and lactation there is increased mobilization of calcium in the mother to meet the fetus' calcium requirements. Here we discuss the diagnostic challenges, management, and patient perspective of hypercalcemia during pregnancy in two particular cases and in other rare conditions causing hypercalcemia.

Keywords: Familial hypocalciuric hypercalcemia; Hypercalcemia; Parathyromatosis; Pregnancy; Primary hyperparathyroidism.

Fig. 1

a ^*Intravascular fluid expansion causes gestational hypoalbuminemia. The dilutional hypoalbuminemia of pregnancy leads to a decline in total calcium concentration. Ionized calcium on the other hand, remains stable and may provide more accurate information. ^** The increase in 1.25 vitamin D production leads to an increase in intestinal calcium absorption. ^***“Absorptive hypercalciuria of pregnancy”. Postprandial and 24-h urinary calcium excretion increase after 12 weeks, due to increased intestinal calcium absorption supposedly unrelated to increased formation of 1.25 vitamin D in early pregnancy. Fasting urine samples will not be affected by this phenomenon [45]. b ^*Prednison to reduce 1.25OH formation and thus intestinal calcium absorption. ^** Reducing PTH-rp production mammae. ^*** No clinical data during pregnancy, only case reports. In animal studies no abnormalities observed, but it does pass the placenta [31, 46]. Breastfeeding: in animal studies (rat), cinacalcet is found in milk [46].