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Addison’s Disease and Pregnancy

What are some implications for pregnancy with Addison’s disease?

Among the many autoimmune diseases, Addison’s stands out as one with an often delayed diagnosis and an explanation that may not be entirely clear to patients. This is because its symptoms are sometimes vague (fatigue, weakness, weight loss, nausea) and it is relatively rare. Also, it affects an unfamiliar but essential body part – the adrenal glands. This, in turn, makes the issue of pregnancy with Addison’s Disease worrisome to many.

In truth, before the advent of steroid treatment, Addison’s did cause very severe complications in pregnancy. With currently available treatment, women with Addison’s may have a slightly higher risk for preterm delivery, small babies and c-sections, but most will have healthy pregnancies and healthy babies.

Addison’s causes an abnormally low production of several hormones which influence metabolism, blood pressure, immune function, sexual maturation, and the sense of overall well-being. During pregnancy, these hormones increase to accommodate changes in the body. The treatment is replacement corticosteroids with or without additional medications for androgen (i.e. testosterone precursor) replacement.

Women are often concerned about ‘taking hormones’ or ‘using steroids’ in pregnancy but one should remember that this is replacing something your body is missing, not adding extra chemicals or un-natural substances to the body. Women need an increase in steroids during labor or for a c-section due to the increased stress on the body and may need to increase levels during the higher-stress, lower-sleep times of newborn parenting.

As with all disease management in pregnancy, it is often useful and recommended to consult with a high-risk obstetrician (Maternal-Fetal Medicine) or an endocrinologist who is comfortable managing pregnant patients. Your midwife or regular doctor can make this referral if you both agree that it would be useful.

If I have Addison’s before getting pregnant, what are some treatment and other considerations while trying to get pregnant?

Before attempting conception, you should be on prenatal vitamins with adequate folic acid (at least 800mcg) for at least three months and your cortisol levels, blood pressure and blood sugar should all be consistently in a normal, healthy range. Addison’s should not interfere with fertility if it is managed. You should also have discussed your plans with you endocrinologist and your midwife or obstetrician. Of course, always work hard toward healthy nutrition, adequate rest and exercise-as-tolerated.

What will happen to my symptoms and treatment while I am pregnant?

Unlike many other autoimmune diseases, Addison’s symptoms are unlikely to be reduced by the immune suppression of pregnancy (for example, some people with RA or lupus notice a decrease in their pain during pregnancy) because the destruction to the adrenal glands has already occurred. Your symptoms should be controlled by your medications though. Typically, medication levels will stay the same in the earlier part of pregnancy and require an increase toward the end of pregnancy and delivery. Levels must be monitored throughout.

What are some signs that I might have onset of Addison’s disease during pregnancy?

Fortunately, this is quite rare. Very severe vomiting, low blood pressure, abnormal blood sugars, tanning or orange discoloration of the skin could all be indicative of Addison’s onset. Any of these in combination with a baby who is not growing well should certainly raise a flag for testing. Unfortunately, aside from the skin discoloration, many of these are common pregnancy complications, as well, so diagnosis could be delayed or missed.

Could the condition worsen during pregnancy or afterward?

Addison’s doesn’t have the progressive degeneration of other, more system-wide autoimmune diseases; once the adrenals are destroyed, they can’t get much worse. However, anytime there is an increase of stress on the body, medications will need to be increased (functioning adrenal glands would naturally increase production of steroids during stress). Once life normalizes, however, most people can resume a fairly standard dose of steroids. Of course, anyone with one autoimmune disease is at higher risk of developing other autoimmune conditions.

Questions for your doctor

  • How will my hormone levels be monitored and how often?
  • Are there any specific dietary recommendations for Addison’s?
  • Do you have any other patients with Addison’s that have had children and might be willing to talk to me?
  • Do you have any other support recommendations?

References:
http://emedicine.medscape.com/article/127772-overview#aw2aab6b6
http://www.mayoclinic.com/health/addisons-disease/DS00361/DSECTION=causes
Addison’s disease increases risk for adverse pregnancy outcomes
Björnsdottir S. J Clin Endocrinol Metab. 2010;doi:10.1210/jc.2010-0108.

 

About the Author
Kathi Kuntz, RN, MSN holds a Bachelor’s and a Master’s Degree in Nursing from the University of Pennsylvania. Her specialization is in the healthcare of women and her graduate research thesis was on autoimmune disease in pregnancy. She has over ten years of clinical practice experience. Currently, Kathi is on an adventure living and traveling with her husband and two young sons in Australia.

 

This post contains opinions of the author.  AutoimmuneMom.com is not a medical practice and does not provide medical advice, diagnosis, or treatment.  It is your responsibility to seek diagnosis, treatment, and advice from qualified providers based on your condition and particular circumstances.  Camino Real Ventures, Inc., the company that makes AutoimmuneMom.com available to you, does not endorse nor recommend any products, practices, treatment methods, tests, physicians, service providers, procedures, clinical trials, opinions or information available on this website.  Your use of the website is subject to our Terms of Use and Privacy Policy

 

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Comments

  1. I’m 7 weeks pregnant with Addison’s disease and hypothyroidism. I’ve been doing everything I’m supposed to be doing like eating right and taking prenatal vitamins. I have very bad shortness of breath accompanied by a rapid heart beat. My endocrinologist says my pregnancy hormones are interfering with the florineff and that I would have to up my salt intake to feel better. I have to literally eat salt out of the palm of my hand to feel better along with broth and pickles. It’s been very challenging. I really liked the article because it was positive about being pregnant with Addison’s disease. Any suggestions for me? Thank you!

    • Dayna, congrats on your pregnancy! I am also about 7 weeks pregnant with my second child. I have Addison’s and Neurally Mediated Hypotension. My advice would be to get in to see your ob and have them refer you to a high risk doctor pretty early on in your pregnancy.
      Just from personal experience, my first pregnancy was very difficult and I was monitored very closely. I had a lot of growth scans and a lot of playing around with my meds to see what was going to work. I was off Florinef at 12 weeks and put on labetalol (not spelled right) for high blood pressure. With this pregnancy, my endo and I are trying to find a safe and healthy dosage of Florinef to hopefully maintain my bp longer. Also, since we are at a higher risk of developing other endocrine issues, I had an early test for gestational diabetes (15 weeks), which I passed! And then I had another one at the normal time (26 weeks), and passed that too!
      As for the sodium, my advice would be to try to keep super hydrated (even more so than when you’re not preggo). Maybe try Gatorade in the morning to get a jump start on the electrolytes.

      FYI, my first son was born in May 29, 2012 at 36 weeks by c-section. He weighed 5lbs 13oz and is now a happy, healthy 2-year-old.

      Best wishes to you during this exciting time. Just try to remain patient and know that we are a special (and strong) breed of women (Addison’s and pregnant). I wish I had a way to give you my personal email. I don’t know about you, but I would LOVE to be able to talk to someone going through the same thing I am right now!

  2. I am 13 weeks pregnant with my 5th child, the first one since my diagnosis with Addison’s. This has so far been my most challenging pregnancy, troubles with low bp, tachycardia, and low sodium. Frequent labs and monitoring by my OB and endocrinologist. But I really feel like I have no idea what I am doing this time! It’s helpful and reassuring to hear others experiences and advice. Thank you!

  3. Ashley Ratigan says:

    Hi there! I am 27 and my husband and I are hoping to try for a baby next year.. It’s terrifying for both of us, because I have had Addison’s for 10 years. It is so comforting to read about your stories and your positive perspective. It would really be great to keep in touch with you.. I have only met one other person with the disease. So, it’s hard for others to relate to the challenges of the condition.

    • Ashley and Jen, I would love to talk to other people with Addison’s disease! If you’re on Facebook, friend me and send me a message so I know who you are. My name is Nicole Buhrman and my profile pic is of my 2yo son and myself. I really hope to hear from you gals!!!

  4. I am currently 36 weeks pregnant with my second child. I have had Addison’s since I was about 12, diagnosed however at 19.

    With my first pregnancy, now 13 years ago, everything went super smooth, with one scary time at 5 months where my heart would not slow to normal rhythm. This time around I have been in and out of hospital about 25 times. I am suffering from extreme nausea and vomiting since about 2 months along. Not to mention an ongoing problem with very low BP. I think having a good rapport with our local emergency department has really been a blessing as they know the second I come in what needs to be done.

    As each woman is different, each pregnancy will be different. If anyone needs to chat please let me know.

  5. Anna Williams says:

    Hi Everyone…I am 31 years old, 6weeks pregnant and diagnosed
    with Addison Disease last week. I am so stressed…which is not a
    good thing…its my first pregnancy and now having to deal with this.I am just wondering how everyone else is doing so far? Thanks

  6. I am due in less than a week with my second child and have Addison’s. I was diagnosed when I was 10 and am now 30. I never had any issues with either pregnancy – was not considered “high risk” and have not had to make adjustments to my medication except for in labor. You should make sure your OB or midwife has it on file that during labor, you will need a “stress does” of your medication since labor puts stress on the body. Definitely talk to your endocrinologist about this if you haven’t already. Also, if you end up with any nausea/vomiting, you may need to take a stress dose (or a few) of your steroids.

  7. I am 29 and had my first baby this past May (2014). My baby is 8 months old now and very healthy and happy. Prior to my pregnancy I had Addison’s for eight years and was pretty stable. Pregnancy went fairly smoothly. I did have high amniotic fluid in the beginning that got a little on the lower side by the end of my pregnancy. My meds needed to be adjusted about three times. I was also told to include additional salt in my diet. There were lots and lots of appointments between obgyn, specialists, endocrinologist, and non stress tests twice a week starting at 28 weeks.
    I was induced into labor. Things went pretty quickly. Had an epidural. My body took a TON of bags of IV during the delivery and my urine bag kept having to be emptied very frequently. When things got intense, the baby’s heart rate was dropping and my blood pressure got very low. But all said and done we survived! I was very puffy after and could hardly lift my legs to get upstairs until the fluid left after about a week and a half or so.
    Now the post partum was very messy. If you are not very carefully monitored both on and coming off of the liquid hydrocortisone it can make you feel very high and manic. I couldn’t sleep. I thought God was healing my Addison’s…I was sending out crazy emails to people, buying things, it was bad and it was scary..and it went on and off for months. By the time I was actually consistently back to normal, the baby was four months old. I have no past history of mental illness either.

    I am reluctant to have a second but my husband really wants another. It was the aftermath that was the hardest for both me and my family. I do feel very blessed to have been able to conceive, carry, and deliver, our very own child though.

  8. priyadharshini baranee says:

    Hai friends,
    I am 32 year old,now we are looking for a baby through ivf,some of my friends are scaring me that my Addison disease will spread to my baby during pregnancy.if it is true,what should I do,if any can guide me.I am in india.
    If any hospital is present in india for this special case.

  9. I’m 28 weeks on Sunday and I have Addisons and hypothyroidism. It’s been a roller coaster ride with my sodium level…it keeps dropping low every so often. I also currently keep waking up with bad headaces, super warm and feeling like I’m sweating. It’s so frustrating to deal with these low sodium levels. Did your cortisone intake get increased during pregnancy? Every time my sodium level increases…my doc ups my steroids. I’m currently taking 35 mg in the am and 20mg in the pm. Isn’t that too much? Any advice would be appreciated…thanks.

    • I mean every time my sodium level decreases…*

    • Hi there,
      I’m almost 8 weeks along with baby #3, and also have Addison’so and hashimoto’a thyroiditis. I to struggle with sodium levels, and did throughout both pervious pregnancies. With my daughter my levels actually dropped to almost 100, and I was hospitalized to get back on track. This time round I’m feeling really awful, but not as bad as the second, I think because my endo automatically doubled my cortisone as soon as we found out. The biggest trouble I’m having now is insomnia as all these steroids are in me.

      For the record, even for all the sodium lows in the past, they were worse in the first trimester, and both babies were born healthy. They’re now a rambunctious 4 and 2 year old.

      Wishing you all the best!

      • I should add that with my first the endo increased my cortisone levels twice during pregnancy, and after my crisis with the second he increased it and it stayed the same from there. This time I’m taking 20 in the morning, 10 at noon, and 10 at 6pm.

  10. Hi there,
    I’m 15 weeks, first pregnancy, 35yrs and have had hashimotos and Addisons diagnosis 18 months ago. I must say the Hashi’s I could deal with, it’s the Addisons I find so hard to accept. I feel it’s robbed me of my regular life – am I’m just so worried that I’m going to pass it onto my baby. I think ive been quite lucky, i didn’t have a lot of nausea at all, just terrible headaches for about 8 weeks. I take 10mg in the morning of hydrocortison and 4mg in the afternoon. I seem to be totally OK on that and my Endo doesnt think we will need to increase too much until the actual labour. Flourineff – has increased though to 1mg per day. I don’t crave salt but it does make me hold fluid which I don’t like, but just have to do whats best for the little bub at this point. I wish all you ladies best of luck with everything. X

  11. Christina Alejandro says:

    Hi I’m 18 and pregnant with my first child I’m 10 weeks pregnant and I was diagnosed with Addison’s disease two years ago. I would like some advice and also to talk to other moms with Addison’s disease to give me an understanding on what to expect and also just to know that everything will be ok

  12. Hello,
    I was diagnosed with Addison’s at 13, and now at 26 am wanting to prepare for trying for a baby in a years time. I was wondering if anyone had a preference to go through the private or public system for their babies ?
    Also I am in Australia, I would really like to be able to chat to another woman in Australia who has Addison’s about pregnancy, hormones and life in general with Addison’s.

  13. Hey everyone!
    I’m 20 years old and this is my first pregnancy. I was diagnosed 2 months before I found out I was pregnant. I’ve recently started doing IV transfusions every week twice a week because my nausea and because I’ve been throwing up so much. It’s hard for me to take my pills because of me being so sick. I’m felling so defeated but I am happy I’ve found this article and there are other women out there like me. I just don’t know what to do anymore.

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  18. Judy Harrison says:

    I was diagnosed with Addison’s 5 years ago and am now 34 weeks pregnant. I’ve had very few issues, and I think the pregnancy so far has been very normal. Baby has steadily measured in the 50th percentile for growth. My hydrocortisone dose has gone from 10mg morning & 10 mg at 5pm to 12.5mg in morning & 10mg at 5pm. I take .01mg of Florinef in morning and at 5pm as well. I’ve noticed more salt cravings and definite lethargy and exhaustion (went to the hospital once because I was worried, but nothing showed up in the bloodwork and they sent me home after monitoring me for a few hours). My doctor said that it’s fairly common to have extreme spells of exhaustion/lethargy if you have Addison’s and are pregnant that don’t show any evidence in bloodwork so that was reassuring. Otherwise the pregnancy has been good so far.

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  21. It us freshing to hear such positives in dealing with Addisons/Adrenal Insufficiency and pregnancy. I’ve read more negatives associated with the condition and the difficulty you will experience during your pregnancy which has been discouraging. I have been adrenal insufficient since 2010, 43 year’s old and 15 weeks pregnant with my 3rd. My spirits are so lifted in reading the POSITIVE posts. I thank God for directing me to autoimmune moms blog and look forward to a healthy pregnancy.

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  27. Are home births or birthing centers ever options for people with Addison’s, or are we automatically considered high risk and stuck in a hospital bed? I am one of those people who get incredibly stressed out just by being in a medical environment, and so I used to always want a home birth if possible if I ever got pregnant. Now with Addison’s, I’m not sure how safe that would be, and I would never risk my health or my child’s health, but I started researching, and I found out that there are some birthing centers (more comfortable, home like environments where you have a bit more control over the birthing process) have nurses and doctors on staff who I assume could give IV steroids during labor. I’m just wondering if anyone out there has done this or anything similar. I’m not pregnant, but I’m one of those people who want to know all of this stuff well ahead of time, lol. I know I’d have to talk to the local places to find out, but I would feel a bit silly asking while obviously not needing their services just yet. And again, I would love to hear from anyone who has gone this route if possible.

  28. Hi I was reading some of these and wow I had no idea there where others out there trying to do what I’m trying/hoping for so I have a question to anyone who can answer this so I have Addison’s was diagnosed bout 5months ago but its been crazy since the Endo says no my PCP says yes the PCP’s test say yes but the one the Endo ran says no still confusing but if in fact I do still have it or it never went away Q: How hard is it to get pregers without treatment I have not been on my meds florinf and cortef for about 2months and am currently TTCing im 31 and for the most part kinda healthy can anyone help?
    Thanks

  29. Kristen says:

    Hello there, my name is Kristen.
    I am 34 years old and living in Canada, newly diagnosed (3 months ago) with Addison’s disease.
    I had one miscarriage immediately prior to my first adrenal crisis and diagnosis.

    My husband and I are starting to think about trying again soon, now that my blood work has stabilized, and my medication is titrated (of course with the thumbs up of my endo).

    I’m wondering if anyone has experience being on prednisone during pregnancy?

    I currently take 6mg of prednisone, and 0.1mg of florinef.

    I’m open to communication via this forum, or via my email, [email protected]

    so refreshing to hear of other women in similar situations who are successfully carrying and delivering healthy babes!

  30. I was diagnosed with Addison’s disease and hypothyroidism in my early thirties. I had my first child at 36 years old. He is now a happy healthy six year old and has brought enormous joy to our lives. It took us over 2 years to conceive him but this was due to male factor fertility issues. I felt very well throughout my pregnancy. I am now 32 weeks pregnant and feeling good but beginning to feel a bit physically tired with carrying the baby weight. I’m now looking to increase my hydrocortisone an extra 5mg a day. Wondering whether others are doing the same at this stage of pregnancy.

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