Management and safety of somatostatin receptor ligands and pegvisomant in pregnant women with acromegaly: a narrative review of the literature.
Pregnancy in women with acromegaly can be managed with careful consideration of treatment strategies, and most pregnancies report favorable fetal outcomes.
Where it sits
this study against the rest of the pasireotide corpusSummary and findings
This narrative review evaluates treatment strategies for pregnant women with acromegaly, focusing on somatostatin receptor ligands and pegvisomant. It includes a total of 120 patients and 134 pregnancies, with findings on maternal and neonatal outcomes. The review also contributes an additional case of pasireotide exposure during pregnancy.
Abstract
Pregnancy in acromegaly is a rare event. Its management is still a challenge given the lack of data, the risk of tumor progression and maternal-fetal complications. This study aims to evaluate the impact of different treatment strategies, particularly somatostatin receptor ligands (SRL) and pegvisomant (PEG), on maternal and neonatal outcomes through a comprehensive review of the literature. We performed a narrative review of the literature. A PubMed search was performed using the keywords "acromegaly AND pregnancy", combined with treatment-related terms, covering publications from January 1, 1988, to January 21, 2026. No publication type restrictions were applied. Additional articles were identified through manual reference screening. Articles published in English and Italian were included. A total of 44 articles were identified, comprising 120 patients and 134 pregnancies; we further contribute an additional case of pregnancy with pasireotide exposure, representing the third reported case of pasireotide exposure during pregnancy. Medical management was categorized as follows: treatment withdrawal before conception (n = 40), discontinuation upon pregnancy confirmation (n = 47), and continuation or modification throughout gestation (n = 30). Symptom worsening occurred in 16.7-40%. Maternal complications included gestational diabetes (5.6-18.8%) and pre-eclampsia (2.8-10.3%). Overall, fetal outcomes were favorable, with only one congenital malformation. Breastfeeding was successfully achieved in most cases. Pregnancy in acromegaly is generally characterized by clinical stability, supporting the safety of treatment withdrawal upon conception in most patients. While early therapy discontinuation is standard, SRL and/or PEG treatment is a viable option for patients requiring tumor and biochemical control. Individualized multidisciplinary management is essential.
Background
Pregnancy in acromegaly is rare and poses management challenges due to potential tumor progression and maternal-fetal complications. Previous literature has shown limited data on the safety and outcomes of treatments during pregnancy. This study aims to synthesize existing literature to provide insights into the management of acromegaly in pregnant women, particularly regarding somatostatin receptor ligands and pegvisomant.
Methods
This narrative review involved a comprehensive literature search on PubMed using specific keywords related to acromegaly and pregnancy. A total of 44 articles were identified, encompassing 120 patients and 134 pregnancies. The review categorized medical management strategies into treatment withdrawal before conception, discontinuation upon pregnancy confirmation, and continuation or modification throughout gestation.
Results
Symptom worsening was reported in 16.7-40% of cases. Maternal complications included gestational diabetes in 5.6-18.8% and pre-eclampsia in 2.8-10.3% of pregnancies. Fetal outcomes were generally favorable, with only one reported case of congenital malformation.
Interpretation
The findings suggest that while symptom worsening and maternal complications are present, the overall fetal outcomes appear favorable. The effect sizes for maternal complications, while statistically significant, may not be clinically meaningful due to the variability in reported rates. Limitations include the narrative nature of the review, which may not provide a comprehensive quantitative analysis and could be influenced by publication bias.
Key findings
- Symptom worsening occurred in 16.7-40%.
- Maternal complications included gestational diabetes (5.6-18.8%) and pre-eclampsia (2.8-10.3%).
- Overall, fetal outcomes were favorable, with only one congenital malformation.
Limitations
- Narrative review may introduce bias.
- Limited quantitative analysis of outcomes.
- Small sample size with only 120 patients.
- Potential publication bias in included studies.