DHEA - Protocol in Pregnancy

DHEA PROTOCOL IN PREGNANCY\n\nCANDIDATES: Recurrent pregnancy loss x2 or greater, consideration for AMA, history of low DHEA, pregnancy loss on progesterone\n\nTESTING: With positive home pregnancy test check HCG x2 48-72 hrs apart and estradiol and DHEA at 4 weeks GA\n\nESTRADIOL LEVELS (per Dr. Boyle):\n4 weeks: Normal 212 (treat if low at 136)\n5 weeks: 287 (191)\n6 weeks: 421 (273)\n7 weeks: 587 (409)\n8 weeks: 734 (545)\n9 weeks: 888 (681)\n10 weeks: 1018\n11 weeks: 1096\n12 weeks: 1569\n\nTREATMENT GUIDELINES:\n- If estradiol low and DHEA low: treat with DHEA. If DHEA <100, recommend more aggressive treatment than if mildly decreased, consider 25 mg daily\n- If estradiol low and DHEA normal: if DHEA 150-200 could consider 5 mg DHEA twice a week then recheck both in 2 weeks. Would not treat if DHEA much above 200\n- If estradiol normal/high and DHEA low: would not treat. Consider repeating levels if DHEA <100\n- If estradiol and DHEA normal: recheck labs at 7 weeks\n\nPer Dr. Check: Typical treatment is 25 mg daily. DHEA may be reduced to 10 mg once daily or doubled to 25 mg twice daily depending on estradiol levels\n\nMONITORING: If supplementing with DHEA check estradiol and DHEA weekly until viability confirmed at 7 weeks by ultrasound after holding DHEA for 2 days\n\nAfter viability confirmed check estradiol and DHEA every 2 weeks after holding DHEA for 2 days\n\nStop supplementation and checking levels at 14 weeks\n\nIMPORTANT: If supplementing with DHEA should take 400 mg vaginal progesterone BID to decrease risk of thrombosis\n\nSAFETY CONCERNS (per Dr. Boyle): Potential risk of thrombosis. No literature on prolonged DHEA supplementation in pregnancy. Studies on long-term pre-IVF use showed 25mg TID x 6 months associated with decreased miscarriages. Side effects minimal but include hair loss, oily skin, acne (androgenic effects). In postmenopausal women 50mg daily x 52 weeks found safe. Monitoring estradiol during pregnancy and only supplementing with low levels believed to prevent abnormally high androgen levels. Increase in maternal DHEA likely reduces production by fetal adrenal gland, preventing excess androgenization. No sexual abnormalities reported in long-term survey of children from DHEA-supplemented pregnancies.