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Guiding diagnosis

New text book answers questions for pregnant and breastfeeding women

Teaching and Learning

By Michelle Osmond

A Faculty of Medicine professor has published a book on endocrinology in pregnant and breastfeeding women, including a groundbreaking chapter on pregnancy and lactation in transgender individuals.

After two years of concerted effort, the 1,000-page textbook, Maternal-Fetal and Neonatal Endocrinology: Physiology, Pathophysiology, and Clinical Management, made it to press in October.

Memorial’s expertise

As an endocrinologist, Dr. Christopher Kovacs says he’s often called on to diagnose and manage endocrine disorders in pregnant women. Some have pre-existing conditions that are more challenging to manage during pregnancy or it’s their first time with an endocrine condition.

In most cases, however, the diagnosis is delayed because the characteristic symptoms and signs are different during these times and would have been dismissed as symptoms during pregnancy or post-partum.

Dr. Kovacs, who is also a University Research Professor at Memorial, says some women are misdiagnosed due to normal changes in hormone levels or a gland during pregnancy or breastfeeding and mistaken for disease. Others have had trouble conceiving because their endocrine condition needs better management.

Professor Christopher Kovacs says there was a gap to fill when it comes to information for pregnant and breastfeeding women
Photo: David Howells

Diabetes and thyroid disorders are the most common endocrine conditions seen during pregnancy and breastfeeding.

“The presentation, available diagnostic techniques and management can differ substantially at these times,” said Dr. Kovacs. “There are also concerns about transmission of hormones or medications into breast milk, and that altered maternal endocrine physiology can affect the developing fetus or neonate. That’s why interventions for the baby may be needed prior to birth or, more commonly, after birth.

“Most endocrinology textbooks ignore pregnancy and breastfeeding, or give a bare few inadequate lines for some disorders,” he continued. “Most obstetrics and gynecology textbooks also ignore all but the most common endocrine disorders during pregnancy, and say little or nothing about post-partum or breastfeeding.”

Filling a gap

Dr. Kovacs says the textbook was necessary to educate specialists due to a lack of information online and in textbooks. Specialists at centres of excellence around the world frequently request his advice and he receives emails from desperate women who need help.

“We mustn’t forget what the women and their partners and families are going through.” — Dr. Chris Kovacs

Second, the book was needed to help train future endocrinologists. Every year Dr. Kovacs contributes to questions on Royal College of Physicians and Surgeons of Canada exams regarding endocrinology during pregnancy or breastfeeding only to discover candidates who had only encountered diabetes and thyroid disorders during pregnancy.

Third, it was written to help prevent clinicians from investigating pregnant women unnecessarily for what are normal changes in hormones or other blood levels during pregnancy, or for the normal enlargement of the pituitary gland that occurs during pregnancy and especially lactation.

Patients and parents first

There are two essays included at the start of the book to illustrate the plight that pregnant women face when afflicted with endocrine disorders or that parents have when the baby is recognized to have an endocrine problem.

“Because in the end, this book is meant to benefit patients, and while we focus on the diagnostic and therapeutic aspects, we mustn’t forget what the women and their partners and families are going through,” said Dr. Kovacs.

Co-authors of the book represent adult and pediatric endocrinology, obstetrics, neurosurgery, neonatology, pediatrics, basic sciences, nursing, transgender medicine, genetics and genetic counselling with contributions from international and Canadian authors. Locally, Drs. Cathy Murray and Christine Orr from Memorial, and Eastern Health nurse Krista L. Rideout contributed.

“With 110 authors and 53 chapters, it covers everything you’d want and need to know about endocrine physiology and endocrine disorders during pregnancy, lactation and fetal/neonatal development,” noted Dr. Kovacs.

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