Pregnancy outcomes in women with congenital virilizing adrenal hyperplasia

Low fertility rates have traditionally been reported among women with virilizing CAH, especially among those with the salt-wasting variant of this disorder. Pregnancy experience in this population remains limited; however, recent data suggest that fertility rates are significantly improved because of earlier treatment, advances in surgical reconstruction, and improved compliance with therapy. This article reviews the reported pregnancy outcomes in women with CAH and discusses the importance of careful endocrine monitoring during gestation. Placental aromatase activity is the principal mechanism that protects the female fetus from the virilizing effects of maternal hyperandrogenism. issues concerning preconception counseling and specific guidelines for the management of pregnancy and delivery in these women are also discussed.