Hypercalcaemia during pregnancy: Review of maternal and fetal complications, investigations, and management

Introduction: Asymptomatic mild primary hyperparathyroidism is increasingly being identified during pregnancy. Recent studies have demonstrated inconsistent findings with regard to pregnancy complications and the need for surgical intervention during pregnancy. 

Method: A retrospective audit of outcomes of pregnancies complicated by hypercalcaemia over a 15-year period was performed. 

Results: Twenty-nine pregnancies to 26 women with hypercalcaemia were identified, corresponding to 37 cases per 100,000 deliveries. Hypercalcaemia was due to primary hyperparathyroidism in 90% of cases, with mean serum calcium of 2.89 mmol/l and mean ionised calcium 1.43 mmol/l. Four women underwent successful neck exploration during pregnancy. Pregnancy complications were limited to three cases of pre-eclampsia and one case of symptomatic neonatal hypoparathyroidism. 

Conclusion: Close observation without surgical intervention would seem reasonable in women with mild hypercalcaemia during pregnancy.