SAT-272 - Pregnancy Outcomes and Experiences in Women with Primary Aldosteronism: Insights from an International Survey

Background: Primary aldosteronism (PA) is a common cause of hypertension and confers cardiovascular risk independent of blood pressure. However, the role of PA in pregnancy-related hypertension and adverse obstetric outcomes remains poorly defined.

Objective: To examine blood pressure patterns, obstetric complications, and pregnancy experiences among women with PA.

Study

Design: We conducted an international, online, cross-sectional survey of women with a current diagnosis of PA who had carried at least one pregnancy. The survey was co-designed by clinicians and women with PA, and distributed through patient support groups and endocrine hypertension clinics between May and September 2025. Outcomes included lifetime occurrence of hypertensive disorders of pregnancy (HDP), preeclampsia, gestational diabetes, fetal growth restriction, preterm birth ( < 37 weeks), low birth weight ( < 2.5 kg), and new-onset postpartum hypertension (≥6 weeks). Qualitative free-text responses were analysed using inductive thematic analysis.

Results and

Discussion: A total of 116 women participated (mean age 49.3±11.4 years; BMI 28.8±6.1 kg/m²). Median gravidity and parity were both 2. Mean age at PA diagnosis was 45.8±10.2 years. Median maternal age at delivery was 33.0 years and median gestational age was 39.0 weeks. Reported lifetime obstetric complications included HDP (57%), preeclampsia (39%), gestational diabetes (17%), fetal growth restriction (13%), preterm birth (27%), and low birth weight (16%). Postpartum hypertension occurred in 55 women (48%) and was new-onset in 13. Women with hypertension in pregnancy were diagnosed with PA at a younger age than those without (43.8 vs 48.4 years, p=0.034), but rates of other obstetric complications were similar between groups. Compared to a large Swedish population cohort (1), complication rates in participants were higher than the general population and comparable to women with pre-existing hypertension. This pattern persisted even among participants who did not develop HDP, suggesting that PA-related adverse effects extend beyond blood pressure elevation alone. Qualitative analysis identified two themes: missed diagnostic opportunities during pregnancy and impacts of adverse experiences on future reproductive planning.


Conclusion: Women with PA report high rates of obstetric complications and postpartum hypertension, even in the absence of diagnosed HDP. These findings highlight pregnancy and the postpartum period as a potential window for earlier recognition of PA and underscore the need for prospective studies to inform screening and management strategies in and following pregnancy.

Reference:

1. Crump C, Sundquist J, Sundquist K. Adverse Pregnancy Outcomes and Long-Term Mortality in Women. JAMA Internal Medicine. 2024;184(6):631-40.

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