MON-104 Disease Activity And Maternal-fetal Outcomes In Pregnant Women With Cushing’S Syndrome: A Systematic Review And Meta-analysis

Abstract Disclosure: D.B. Bandeira: None. G.D. Santos: None. A. Glezer: None. M.C. Machado: None. C.L. Boguszewski: None. V.D. Nunes-Nogueira: None. Introduction: Although pregnancy in patients with Cushing's syndrome (CS) is rare, it presents significant challenges due to the increased risk of maternal and fetal complications. Purpose: To evaluate the natural course and maternal-fetal outcomes in pregnant women with Cushing’s Syndrome Methods: We conducted a systematic review following the Joanna Briggs Institute methodology for systematic reviews focused on etiology and risk. We included observational studies with three or more pregnant women diagnosed with CS. The outcomes of interest included spontaneous miscarriage, preterm birth, exacerbation of preexisting diabetes or development of gestational diabetes, arterial hypertension or eclampsia, perinatal mortality, low birth weight, and congenital malformations. We searched the Embase, Medline, LILACS, and CENTRAL databases, and performed proportional meta-analyses using Stata Statistical Software 18. Results: We identified twenty-two studies that included a total of 380 pregnancies, with the mean age of the pregnant women being 30 years. Among the 200 women for whom the etiology of CS was reported, 54% were attributed to Cushing's disease, 24% to adrenal adenoma, 11% to adrenal carcinoma, 4% to primary pigmented nodular adrenocortical disease, 2% to ectopic CS, and 5% presented with Nelson syndrome. Notably, among the 149 pregnant women in whom hypercortisolism control was assessed during pregnancy, only 47% achieved control during this period. The overall frequency of spontaneous miscarriage was 6% (21 studies of 245 pregnancies; 95% CI, 3-13%), and of preterm birth was 36% (18 studies of 341 pregnancies; 95% CI, 23-52%). Additionally, worsening of preexisting diabetes or development of gestational diabetes occurred in 23% (16 studies of 343 pregnancies; 95% CI, 13-38%) and arterial hypertension or eclampsia in 39% (19 studies of 361 pregnancies; 95% CI, 23-57%). Two studies assessed the frequency of thromboembolic events, reporting only one occurrence among 134 pregnancies. The overall frequency of perinatal mortality was 7% (18 studies of 341 newborns; 95% CI, 3-13%), 27% (11 studies of 113 newborns; 95% CI, 15-43%) for low birth weight, and 1% for congenital malformations (11 studies of 306 newborns; 95% CI, 0-7%). No maternal mortality was reported. Conclusion: Approximately half of the pregnancies occurred during periods of uncontrolled hypercortisolism. The perinatal mortality, low birth weight, and preterm birth rates were increased in pregnant women with CS in relation to reported prevalences in pregnant women without CS. FAPESP grants: 2024/07690-7 and 2024/03507-3. Presentation: Monday, July 14, 2025