Comparison Between Surgical and Non-Surgical Management of Primary Hyperparathyroidism During Pregnancy: A Systematic Review

Abstract

Abstract Purpose Primary hyperparathyroidism during pregnancy is an uncommon condition that may have consequences for either the mother, newborn, or both. Treatment options can be surgical or conservative. This study aimed to compare adverse outcomes associated with surgical versus non-surgical treatment to determine the favorable management option. Additionally, the study investigated the correlation between serum calcium values and complication rates. Methods A systematic review of retrospective studies, case series, and case reports. Biochemical parameters, interventions, and outcomes of each pregnancy were recorded. The study population comprised two groups: the non-surgical and surgical groups. Adverse outcomes were categorized as maternal, obstetric, or neonatal. Statistical analysis was conducted to compare outcomes between the study groups. Results The surgical and non-surgical groups consisted of 163 and 185 patients, respectively. Among the entire study population, gestational primary hyperparathyroidism (PHPT) led to maternal, obstetric, and neonatal complications in 19.5%, 32%, and 26.7% of cases, respectively. Although the mean serum calcium was higher in the surgical group (12.3 mg/dL compared with 11.1 mg/dL for the non-surgical group), no significant differences were observed in maternal outcomes and overall obstetric outcomes between the study groups. A positive correlation was observed between the mean maternal gestational calcium value and both maternal and obstetric complications, but not neonatal complications. Nonetheless, neonatal complications occurred at higher rates across all calcium values when patients were treated conservatively (p < 0.001). Conclusions Given the significant difference in neonatal adverse outcomes across all calcium values in the non-surgical group, along with non-inferior outcomes in the surgical group, the overall data of this study suggest that parathyroidectomy is favorable to non-surgical management even in cases of mild hypercalcemia.