Cushing's Syndrome During Pregnancy: Risks to Mother and Baby

Cushing's syndrome during pregnancy is a rare hormone disorder that occurs when the body is exposed to abnormally high levels of the hormone cortisol, usually because of a pituitary or adrenal problem. It raises the mother's risk of high blood pressure, diabetes, and preeclampsia, and the baby's risk of preterm birth, low birth weight, and stillbirth. Early diagnosis and treatment improve outcomes, and many women deliver healthy babies.



We spoke to Dr Nandita Palshetkar, Scientific Director & Head of the Bloom IVF Unit at Lilavati Hospital, Mumbai, and Medical Director of Bloom IVF Centres, for expert insight on this condition.



What Is Cushings Syndrome, and Why Is It Rare in Pregnancy?Cushing's syndromedevelops when the body is exposed to excessively high levels of cortisol for a prolonged period. The cause may be an adrenal gland tumour, a pituitary tumour (Cushing's disease) that produces excess adrenocorticotropic hormone (ACTH), or long-term use of steroid medicines.



Excess cortisol disrupts ovulationand periods, making pregnancy uncommon. When it does occur, diagnosis is harder because normal changes such as weight gain, stretch marks, and high blood sugar mimic Cushing's syndrome.



Normal Pregnancy vs Cushings Syndrome: Key DifferencesDiagnosis can be difficult because several features overlap with normal pregnancy. However, certain findings may raise suspicion, especially when they are pronounced or appear together.

Feature	Normal pregnancy	Cushing's syndrome
Stretch marks	Thin, pink or silvery lines on the abdomen, hips and breasts	Wide, purple or violaceous marks that may also appear on the thighs, armpits and arms
Weight gain	Steady gain, mainly over the belly, hips and breasts	Fat gathers on the trunk and upper back (buffalo hump), while the arms and legs stay thin
Face	Mild puffiness	Rounded, full face
Skin	Firm skin, with mild acne in some women	Thin skin, easy bruising, and marked acne
Muscle strength	Tiredness is common, but strength is normal	Weakness, with difficulty climbing stairs or rising from a chair
Hair	Hair thickens, with shedding after delivery	Excess facial or body hair, and hair loss
Blood pressure	Gestational hypertension usually appears after 20 weeks	Rises early (around 16 weeks) or is hard to control
Blood sugar	Gestational diabetes is usually found at screening around 24 to 28 weeks	High blood sugar that appears early or is hard to control
Potassium	Normal on blood tests	Low on blood tests
Infections	Occasional	Recurrent or slow-to-clear

Risks of Cushing's Syndrome to the MotherUntreated or poorly controlled Cushing's syndrome can increase the risk of several complications.

• High blood pressure and pre-eclampsia: Excess cortisol can contribute to hypertension during pregnancy. Women with Cushing's syndrome are also at increased risk of pre-eclampsia.
• Gestational diabetes: Cortisol increases blood glucose levels and can reduce insulin sensitivity. As a result, women with Cushing's syndrome may developdiabetesor have difficulty controlling existing high blood sugar during pregnancy.
• Blood clots and infections:

Cushing's syndrome can increase the risk ofblood clots (venous thromboembolism). Excess cortisol can also affect immune function, increasing susceptibility to infections. Risks of Cushing's Syndrome to the BabyHigh maternal cortisol levels can affect pregnancy and foetal outcomes. Reported complications include:

• Preterm birth
• Poor foetal growth orlow birth weight
• Pregnancy loss
• Foetal or neonatal complications
• Low blood sugar in the newborn
• Respiratory problems after birth

How Is Cushing's Syndrome Treated During Pregnancy?Treatment depends on the cause, severity, and stage of pregnancy. The aim is to reduce excessive cortisol while protecting the mother and foetus.

• Surgery: Removing the tumour by laparoscopic adrenalectomy or pituitary surgery is preferably done in the second trimester, before 24 weeks. Steroid cover is needed afterwards to prevent adrenal insufficiency.
• Medicine: Medication is considered when surgery is not possible or while preparing for surgery. Because evidence on medicines for Cushing's syndrome during pregnancy is limited, treatment requires specialist assessment rather than self-medication.
• Monitoring: Regular blood pressure checks, blood sugar tests, and baby growth scans.

Cushing's syndrome during pregnancy requires close specialist monitoring, but identifying excess cortisol early and managing its cause can help reduce complications.



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FAQs on Cushing's Syndrome During Pregnancy: Risks to Mother and Baby

Can you get pregnant with Cushing's syndrome?

Yes, but it is uncommon because high cortisol disrupts ovulation and periods. Women whose cortisol is controlled before pregnancy have a lower risk of complications.

Is Cushing's syndrome dangerous for the baby?

It can be. Untreated disease raises the risk of preterm birth, low birth weight, and stillbirth.

What are the first signs of Cushing's syndrome in pregnancy?

Early high blood pressure, raised blood sugar, a rounded face, fat on the upper back, acne, excess hair, and muscle weakness.