Table 6.

Summary of recommendations for PHPT and HypoPT during preconception, pregnancy, and lactation.

	PHPT	HypoPT
Mother (preconception)	Pregnancy should be avoided until curative surgery has been performed and calcium concentrations are normalized	Counselling regarding frequent surveillance and potential changes in vitamin D and calcium requirements during pregnancy Most mothers will have a healthy baby
Mother (pregnancy)	Surgery is advised, preferentially in the second trimester, and especially if albumin-adjusted calcium is >2.85 mmol/L (>11.42 mg/dL) and/or >0,25 mmol/L (>1 mg/dL) ULN and/or ionized calcium is >1.45 mmol/L (>5.81 mg/dL) Surveillance every 4 weeks	Calcium and vitamin D supplements, as well as active vitamin D treatment can be used Aim for ionized and/or albumin-adjusted calcium levels in the lower end of the reference range. Surveillance every 3–4 weeks; each week during the last month of pregnancy
Mother (lactation)	Surveillance every 4–8 weeks Surgery a few weeks after delivery	Surveillance weekly within the first month after birth and then every 4 weeks
Newborns	Measure ionized calcium every second day until about 1–2 weeks of life In case of hypocalcemia, consider active vitamin D treatment	Measure ionized calcium every second day during the first week of life

HypoPT, chronic hypoparathyroidism; PHPT, primary hyperparathyroidism; ULN, upper limit of normal.