Abstract
Perinatal characteristics of children with non-acquired GHD are highly variable. Children with structural hypothalamic-pituitary abnormalities such as ectopic posterior pituitary (EPP) with/without pituitary stalk interruption syndrome, septo-optic dysplasia (SOD), or isolated anterior pituitary aplasia/hypoplasia (AP/HP) usually display more severe GHD than those with normal hypothalamic-pituitary magnetic resonance imaging (MRI) findings, and a higher prevalence of multiple pituitary hormone deficiencies (MPHD). Birth and perinatal characteristics in patients with structural hypothalamic-pituitary findings were assessed using data from the Genetics and Neuroendocrinology of Short Stature International study (GeNeSIS). Patients were grouped according to investigator-provided diagnoses: 1) EPP (N=396; including interrupted pituitary stalk; reported MPHD 57%); 2) SOD (N=202; MPHD 78%); 3) AP/HP (N=509; MPHD 36%); and 4) Other GHD (N=10470; non-acquired, non-pituitary abnormality associated; MPHD 9%). Birth/perinatal characteristics for EPP were compared to other diagnoses by ANOVA (all other diagnoses) and pairwise using Dunnett adjustment for continuous variables, and Chi-Square (all other diagnoses) and Fisher’s exact test (pairwise) for categorical variables. Gestation duration was ≈39 weeks for all diagnoses. Mean birth weight standard deviation scores (SDS) were 0.02 for EPP, -0.11 for SOD (p value for difference from EPP=0.651), -0.26 for AP/HP (p=0.020), and -0.38 for Other (p<0.001), while birth length SDS were -0.44, -0.17 (p=0.257), -0.60 (p=0.370) and -0.74 (p=0.003) respectively. Breech presentation was reported for 15% in the EPP group vs 3% SOD, 7% AP/HP and 5% Other (p<0.001 pairwise from EPP for all), with higher rates of reported Caesarean section for EPP (21%) vs SOD (17% [p=0.280]), AP/HP (17% [p=0.104]), and Other (14% [p<0.001]) or instrument assisted delivery (5%, 2% [p=0.167], 2% [p=0.033], and 2% [p=0.001] respectively). Perinatal asphyxia, then pregnancy, delivery, and neonatal complications were most prevalent for EPP and/or SOD, with values for EPP vs Other of 10% vs 3%, 18% vs 8%, 11% vs 4%, 35% vs 8%, respectively (p<0.001 for all) and 13% (p=0.027), 10% (p=0.911), 8% (p=0.249), 20% (p<0.001) respectively for AP/HP. In conclusion, among children with GHD, those with structural hypothalamic-pituitary abnormalities had delivery and perinatal complications more frequently than those without such MRI findings, but had birth weight and length SDS closer to the general population average. These findings from a large cohort of children with GHD reinforce previous smaller series suggesting that patients with congenital CNS midline defects and ultimately GHD or MPHD were more likely to have had complications during pregnancy and delivery, although causality is not established.