Effect of subclinical hypothyroidism and autoimmunity on adverse pregnancy and neonatal outcome in our population

Abstract Background Levothyroxine replacement therapy may decrease the risk of adverse pregnancy outcomes among women with subclinical hypothyroidism (SCH). The aim of this study is to conduct a systematic review and meta-analysis to examine the risk of adverse pregnancy, perinatal, and early childhood outcomes among women with SCH treated with levothyroxine. Methods A systematic literature search was conducted using Ovid-Medline, Ovid-EMBASE, Pubmed (non-Medline), Ebsco-CINAHL Plus with full text and Cochrane Library databases. Randomized controlled studies (RCTs) and observational studies examining the association between treatment of SCH during pregnancy and our outcomes of interest were included. Studies that compared levothyroxine treatment versus no treatment were eligible for inclusion. Data from included studies were extracted and quality assessment was performed by two independent reviewers. Results Seven RCTs and six observational studies met our inclusion criteria. A total of 7342 individuals were included in these studies. RCTs demonstrated several sources of bias, with lack of blinding of the participants or research personnel; only one study was fully blinded. In the observational studies, there was moderate to serious risk of bias due to lack of adjustment for certain confounding variables, participant selection, and selective reporting of results. Pooled analyses showed decreased risk of pregnancy loss (RR: 0.79; 95% CI: 0.67 to 0.93) and neonatal death (RR: 0.35; 95% CI: 0.17 to 0.72) associated with levothyroxine treatment during pregnancy among women with SCH. There were no associations between levothyroxine treatment and outcomes during labour and delivery, or cognitive status in children at 3 or 5 years of age. Conclusion Treatment of SCH with levothyroxine during pregnancy is associated with decreased risks of pregnancy loss and neonatal death. Given the paucity of available data and heterogeneity of included studies, additional studies are needed to address the benefits of levothyroxine use among pregnant women with SCH.

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Prevalence of sub clinical hypothyroidism and pregnancy outcome: a prospective comparative study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20200909 ◽

2020 ◽

Vol 9 (3) ◽

pp. 1250

Author(s):

Bilal Ur Rehman ◽

Hiba Gull

Keyword(s):

Comparative Study ◽

Pregnant Women ◽

Pregnancy Outcome ◽

Subclinical Hypothyroidism ◽

Apgar Score ◽

Adverse Pregnancy Outcome ◽

Significant Risk ◽

Overt Hypothyroidism ◽

Prospective Comparative Study ◽

Adverse Pregnancy

Background: In pregnancy, subclinical hypothyroidism is more common than overt hypothyroidism, ranging from 15% to 28% in Iodine sufficient region. Evidence suggests that subclinical hypothyroidism is associated with adverse pregnancy outcome. The aim of this study was to find the prevalence of subclinical hypothyroidism in pregnant women and adverse pregnancy outcome.Methods: This hospital based prospective comparative study was conducted over a period of 6 months from 1st July 2018 to 31st December 2018 in department of obstetrics and gynecology SKIMS Soura Kashmir. All the subjects who fulfilled the inclusion criteria and who consented to participate were screened for subclinical hypothyroidism.Results: A total of 175 pregnant women participated in the study and subclinical hypothyroidism was diagnosed in 25 pregnant women (14.2%). Most of our patients were in age group 21 to 30 years (69.1%). Pregnant women with subclinical hypothyroidism had significant risk of preeclampsia (35%) and higher cesarean section rate (29.6%). Neonate of women with subclinical hypothyroidism had higher incidence poor Apgar score, NICU admission.Conclusions: The prevalence of subclinical hypothyroidism is high in pregnant women and the gravity of the complications like pre-eclampsia, neonate with low Apgar score, increased NICU admission, overweight the cost of screening. In this view, we propose screening of all pregnant women in the first trimester for diagnosis.

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A mystery mass on the placenta

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2019-0002 ◽

2019 ◽

Vol 40 (2) ◽

Author(s):

Evelyn Lee Pian Ting ◽

Soon Leong Yong ◽

Ganapaty Suhashini ◽

Marcus Kang

Keyword(s):

Pregnancy Outcomes ◽

Pregnancy Complications ◽

Neonatal Outcome ◽

Preterm Labour ◽

Histopathological Examination ◽

Good Condition ◽

Transabdominal Ultrasound ◽

Antenatal Corticosteroids ◽

Extremely Preterm ◽

Adverse Pregnancy

Abstract Chorioangioma or chorangioma is a benign placental tumour which occurs in 1% of the pregnancies. Large lesions of more than 4–5 cm in size, also known as giant chorangiomas, are rare with the incidence of 1:3500 and 1:9000 birth. Unlike small tumours, the giant chorangiomas are highly associated with pregnancy complications. We report a case of multiple large chorangiomas resulting in an extremely preterm delivery. A 24-year-old primigravida presented at 25 weeks of gestation for threatened preterm labour. Transabdominal ultrasound revealed an echogenic mass on the placenta measuring 8.7 × 4.4 cm. Following a successful tocolysis and administration of a course of antenatal corticosteroids, she was discharged home. At 27 weeks of gestation, she developed a second episode of preterm contractions. Besides, the foetus was found to be small for gestational age. In the second episode of preterm contractions, intravenous magnesium sulfate infusion was commenced for foetal neuroprotection. Tocolysis was commenced for severe prematurity. She went into spontaneous preterm labour. Placenta examination revealed multiple solid masses with fleshy and congested dark red surface. A histopathological examination of the placenta confirmed the diagnosis of chorangiomas. The baby was discharged in good condition at 5 months of age. Placental chorangiomas, notably when they are multiple and large in size, are associated with adverse pregnancy outcomes. Therefore, close antenatal surveillance is necessary to allow timely recognition and intervention of pregnancy complications. Our case portrays an unexpected favourable neonatal outcome associated with a giant chorangiomas.

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Impact of TPOAb-negative maternal subclinical hypothyroidism in early pregnancy on adverse pregnancy outcomes

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/20420188211054690 ◽

2021 ◽

Vol 12 ◽

pp. 204201882110546

Author(s):

Ping Zhu ◽

Ruifeng Chu ◽

Shilei Pan ◽

Xiaolan Lai ◽

Jianmin Ran ◽

...

Keyword(s):

Confidence Interval ◽

Early Pregnancy ◽

Subclinical Hypothyroidism ◽

Pregnancy Outcomes ◽

Odds Ratio ◽

Thyroid Stimulating Hormone ◽

Adverse Pregnancy Outcomes ◽

American Thyroid Association ◽

Adverse Pregnancy ◽

Stimulating Hormone

Purpose: To investigate the effect of subclinical hypothyroidism on pregnancy outcomes of women early in their pregnancy with different thyroid-stimulating hormone levels and thyroid peroxidase antibody–negative status and to explore reasonable thyroid-stimulating hormone levels for subclinical hypothyroidism in early pregnancy. Methods: A total of 2378 women early in their pregnancy were studied retrospectively. The baseline characteristics were collected from medical records. Pregnancy outcomes were compared between the euthyroidism and subclinical hypothyroidism groups that were diagnosed by 2011 or 2017 American Thyroid Association guidelines. In addition, the effect of different maternal thyroid-stimulating hormone levels on adverse pregnancy outcomes was analyzed using binary logistic regression. Results: According to the 2011 American Thyroid Association diagnostic criteria of subclinical hypothyroidism, the prevalence of pregnancy outcomes was not significantly higher in the subclinical hypothyroidism group than in the euthyroidism group. However, pregnant women with subclinical hypothyroidism identified by the 2017 American Thyroid Association criteria had a higher risk of premature delivery (odds ratio = 3.93; 95% confidence interval = 1.22–12.64), gestational diabetes mellitus (odds ratio = 2.69; 95% confidence interval = 1.36–5.32), and gestational anemia (odds ratio = 3.28; 95% confidence interval = 1.60–6.75). Moreover, no differences in the prevalence of adverse pregnancy outcomes were observed between the mildly elevated thyroid-stimulating hormone group (2.5 < thyroid-stimulating hormone ⩽4.0 mIU/l) and the normal thyroid-stimulating hormone group (0.27 < thyroid-stimulating hormone ⩽2.5 mIU/l). The significantly elevated thyroid-stimulating hormone group (4.0 < thyroid-stimulating hormone < 10.0 mIU/l) had a higher prevalence of premature delivery, gestational diabetes mellitus, and gestational anemia than the normal thyroid-stimulating hormone group, even after controlling for potential confounding factors. Conclusion: A mildly elevated thyroid-stimulating hormone level or maternal subclinical hypothyroidism diagnosed by 2011 American Thyroid Association guidelines during early pregnancy in thyroid peroxidase antibody–negative women was not associated with adverse pregnancy outcomes. However, maternal subclinical hypothyroidism identified by the 2017 American Thyroid Association guidelines increased the risks of several adverse pregnancy outcomes in women untreated with levothyroxine. The 2017 American Thyroid Association guidelines could be more reasonable for the diagnosis of subclinical hypothyroidism in southern China.

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Pregnancy outcome in women treated for subclinical hypothyroidism detected in early gestation

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180194 ◽

2018 ◽

Vol 7 (2) ◽

pp. 685

Author(s):

Raja Rajeswari C. ◽

Suman Paul ◽

Madhusmita Nayak

Keyword(s):

Pregnancy Outcome ◽

Subclinical Hypothyroidism ◽

Adverse Pregnancy Outcome ◽

Treated Group ◽

Endocrine Disorders ◽

Free T4 ◽

Early Gestation ◽

Significant Difference ◽

Gestational Age At Delivery ◽

Adverse Pregnancy

Background: Thyroid disorders are among the most common endocrine disorders in pregnancy. Objective of present study were to investigate the outcome of pregnancy in those women detected to have subclinical hypothyroidism in early gestation and to evaluate whether treatment of subclinical hypothyroidism reduces the adverse pregnancy outcome.Methods: Pregnant women detected to have Subclinical hypothyroidism (TSH >2.5- 6 mU/L and N Free T4) in the 1st trimester were selected and randomly divided into 2 groups. One group received treatment with Thyroxine. They were followed up till delivery and outcome noted.Results: The mean maternal age of both the group was 26 yrs. The gestational age at delivery and the newborn birth weight did not show any statistically significant difference. Antenatal complications like Gestational Diabetes, hypertension, small for gestation, and preterm were almost the same in both groups. There was significant increase in the primary caesarean rate in the treated group. No significant difference in the number of term vaginal delivery in both groups.Conclusions: Treatment of women with SCH (TSH <6 mU/L) does not reduce the risk of adverse pregnancy outcome. Benefits of treatment need to be weighed against any potential risks.

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Implantation failure in rats with subclinical hypothyroidism is associated with LIF/STAT3 signaling

Endocrine Connections ◽

10.1530/ec-19-0185 ◽

2019 ◽

Vol 8 (6) ◽

pp. 718-727 ◽

Cited By ~ 3

Author(s):

Ling Shan ◽

Yingying Zhou ◽

Shiqiao Peng ◽

Xinyi Wang ◽

Zhongyan Shan ◽

...

Keyword(s):

Early Pregnancy ◽

Subclinical Hypothyroidism ◽

Overt Hypothyroidism ◽

Implantation Failure ◽

Oh Groups ◽

Stat3 Signaling ◽

Stat3 Signaling Pathway ◽

Increased Risk ◽

Implantation Sites ◽

Adverse Pregnancy

Background Pregnant women with subclinical hypothyroidism are associated with an increased risk of spontaneous abortion. This study aims to investigate the mechanisms underlying the effects of maternal subclinical hypothyroidism during early pregnancy on abortion in the uterus, focusing upon the LIF/STAT3 signaling pathway. Methods One hundred five Wistar rats were randomly divided into three groups (35 rats in each group): control (CON) group, subclinical hypothyroidism (SCH) group and overt hypothyroidism (OH) group. We examined the weight of rat uteri, rat placenta and embryos. We also determined the number of implantation sites and the embryo absorption rates. The protein and mRNA expressions of TSHR, TR-α, TR-β, LIFR, gp130, JAK1, p-STAT3 and STAT3 were measured by immunohistochemical staining, real-time PCR and Western blotting. Results The weights of rat uteri, rat placenta and embryos were significantly reduced in the SCH and OH groups. The number of implantation sites was significantly decreased in the SCH and OH groups, while embryo absorption rates were significantly increased. The mRNA and protein expressions of TSHR were upregulated in the SCH and OH groups, while TR-α and TR-β showed no difference when compared between the three groups. The expression levels of LIFR, gp130, JAK1 and p-STAT3 were significantly higher in the SCH and OH groups. Conclusions Clinical and subclinical hypothyroidism during early pregnancy might cause adverse pregnancy outcomes. Implantation failure in rats with subclinical hypothyroidism was associated with abnormal LIF/STAT3 signaling.

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Thyroid disorder in antenatal women in sub-himalayan region: a need for universal screening

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20173460 ◽

2017 ◽

Vol 6 (8) ◽

pp. 3445

Author(s):

Swati Dubey ◽

Anup Pradhan

Keyword(s):

Gestational Age ◽

Subclinical Hypothyroidism ◽

Universal Screening ◽

Thyroid Dysfunction ◽

Fetal Outcome ◽

Thyroid Disorder ◽

Singleton Pregnancy ◽

Adverse Pregnancy ◽

Pregnant State ◽

In Pregnancy

Background: Thyroid dysfunction constitutes the second most common endocrine disorder of pregnancy, associated with adverse maternal and fetal outcome and is often overlooked in pregnancy due to their nonspecific symptoms and the hypermetabolic pregnant state. Objective of present study was to establish the prevalence of thyroid dysfunction, study the effects in pregnancy in sub-himalayan population and whether universal screening for thyroid dysfunction is required.Methods: The study was conducted on 200 patients in the age group of 20 to 35 years with a singleton pregnancy and gestational age between 6 to 24 weeks.Results: In the 200 women screened, the prevalence of thyroid dysfunction was found to be 14% with 8% having subclinical hypothyroidism while an equal percentage of 2% having clinical hypothyroidism, subclinical hyperthyroidism and clinical hyperthyroidism. The mean age of patients with subclinical hypothyroidism was 28.6 ± 4.9 years, with thyroid disorder in pregnancy being significantly more common in primigravida. Statistically significant association was found between patients with thyroid dysfunction and abortions, preeclampsia, preterm labor, small for gestational age, low birth weight, and admission to NICU.Conclusions: Prevalence of thyroid dysfunction was found to be high in our study, particularly subclinical hypothyroidism and was associated with adverse pregnancy outcomes; hence, more research is required in the Sub-Himalayan goitre belt to assess the magnitude of the problem and formulate universal screening protocols in this particular subset of the Indian population accordingly.

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Subclinical Hypothyroidism in Women Planning Conception and During Pregnancy: Who Should Be Treated and How?

Journal of the Endocrine Society ◽

10.1210/js.2018-00090 ◽

2018 ◽

Vol 2 (6) ◽

pp. 533-546 ◽

Cited By ~ 9

Author(s):

Spyridoula Maraka ◽

Naykky M Singh Ospina ◽

George Mastorakos ◽

Derek T O’Keeffe

Keyword(s):

Pregnant Women ◽

Subclinical Hypothyroidism ◽

Careful Consideration ◽

Reproductive Age ◽

Current Evidence ◽

Thyroid Function Tests ◽

Neurocognitive Deficits ◽

Increased Risk ◽

Common Diagnosis ◽

Adverse Pregnancy

Abstract Subclinical hypothyroidism (SCH), a mild form of hypothyroidism defined as elevated TSH with normal free thyroxine levels, is a common diagnosis among women of reproductive age. In some, but not all, studies, it has been associated with infertility, an increased risk of adverse pregnancy and neonatal outcomes, and possibly with an increased risk of neurocognitive deficits in offspring. Despite well-established recommendations on treatment of overt hypothyroid pregnant women, a consensus has not yet been reached on whether to treat women with SCH. This review focuses on examining the evidence informing the clinical strategy for using levothyroxine (LT4) in women with SCH during pregnancy and those who are planning conception. A crucial first step is to accurately diagnose SCH using the appropriate population-based reference range. For pregnant women, if this is unavailable, the recommended TSH upper normal limit cutoff is 4.0 mIU/L. There is evidence supporting a decreased risk for pregnancy loss and preterm delivery for pregnant women with TSH > 4.0 mIU/L receiving LT4 therapy. LT4 treatment has been associated with better reproductive outcomes in women with SCH undergoing artificial reproductive techniques, but not in those who are attempting natural conception. Thyroid function tests need to be repeated throughout pregnancy to monitor LT4 therapy. In addition to potential harms, LT4 contributes to treatment burden. During a consultation, clinicians and patients should engage in a careful consideration of the current evidence in the context of the patients’ values and preferences to determine whether LT4 therapy initiation is the best next step.

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A RARE CASE OF FAVOURABLE PREGNANCY OUTCOME FOLLOWING CONTRACEPTION FAILURE WITH INTRAUTERINE DEVICE IN SITU AMIDST 'LOCKDOWN' DURING COVID-19 PANDEMIC

10.36106/ijsr/3032752 ◽

2021 ◽

pp. 70-72

Author(s):

Jayanta Kumar Biswas ◽

Ganesh Saravagi

Keyword(s):

Neonatal Outcome ◽

Early Stage ◽

Intrauterine Device ◽

Contraceptive Device ◽

Healthy Baby ◽

Intrauterine Contraceptive ◽

Obstetric Emergencies ◽

Adverse Pregnancy ◽

Reliable Methods

Different reliable methods of contraception are used. However, women still get pregnant when it fails. It would be dramatic when a lady has an intrauterine device in place and still she conceive and delivers a healthy baby at term. Failure rate of copper containing intrauterine contraceptive device (IUCD) is usually less than 2 women per 100 women years. Pregnancy continued with IUCD in situ can result in adverse pregnancy and neonatal outcome in comparison to its removal at an early stage of pregnancy. Early detection of pregnancy with IUCD in situ and proper management are very important to avoid many obstetric emergencies later on. The reported case is precisely the same kind of case, where the lady had left with no other option but to continue her pregnancy due to lack of required medical facility early in her gestation, but had a favourable maternal and neonatal outcome.

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