scholarly journals SUBCLINICAL HYPOTHYROIDISM IN PREGNANCY; IS THERE A NEED FOR PHARMACOLOGICAL INTERVENTION?

2017 ◽  
Vol 9 (3) ◽  
pp. 186
Author(s):  
Shripad Hebbar ◽  
Sahan Kumar ◽  
Sapna Amin ◽  
Sneha Doizode
Keyword(s):  
Gestational Diabetes ◽  
Pregnant Women ◽  
Preterm Delivery ◽  
Subclinical Hypothyroidism ◽  
First Trimester ◽  
Pharmacological Intervention ◽  
Complication Rates ◽  
Geographic Population ◽  
First Trimester Of Pregnancy ◽  
Tsh Levels

Objective: To find the prevalence of subclinical hypothyroidism in the first trimester of pregnancy and to compare the maternal and perinatal outcome in them with euthyroid mothers.Methods: The present study was a prospective observational case-control study done in a tertiary hospital over the period of one and half years. Pregnant women in the first trimester of pregnancy were tested for Thyroid Stimulating Hormone (TSH) levels and those who had TSH>2.5mIU/l, free T3 and free T4 estimation was carried out on the same sample. A total of 171 women could be followed up till delivery and their first-trimester thyroid profile was available for analysis. They were grouped into two groups, Group 1: all women with TSH level>2.5 mIU/l, considered to be hypothyroid (n=79), Group 2: women with euthyroid status with TSH levels 0.1 to 2.5 mIU/l (n=95). All the neonates delivered in the first group had cord blood TSH estimation.Results: In the study period, there were 2632 deliveries. The number of pregnant women with first trimester TSH levels>2.5 mIU/l were 79, giving the prevalence rate of 3 % for subclinical hypothyroidism during pregnancy. The obstetric complications observed were gestational hypertension 3.8%, gestational diabetes 6.3%, placenta praevia1.3% and preterm delivery 7.6%. The perinatal complications included Intrauterine growth restriction (IUGR) 1.3%, Low Birth Weight (LBW) 3.8%, perinatal asphyxia 2.5% and neonatal hypothyroidism 1.3%. Only preterm delivery appeared to be significantly associated with subclinical hypothyroidism.Conclusion: The observed complication rates were much similar, in fact, lesser with gestational diabetes, pregnancy hypertension, IUGR, LBW compared to global and Indian prevalence rates. This indicates that the cut-off for diagnosing subclinical hypothyroidism should be derived from TSH assays from the local geographic population and should guide the treating physician to establish appropriate TSH ranges where definite therapeutic intervention is required to improve the maternal and foetal outcome.

scholarly journals Subclinical hypothyroidism (SCH) in first trimester of pregnancy.

2020 ◽  
Vol 27 (11) ◽  
pp. 2474-2477
Author(s):  
Kashif Ali Khan ◽  
Muhammad Saleem Akhter ◽  
Kehkashan Fatima ◽  
Muhammad Waqar Saleem
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Neonatal Death ◽  
Placental Abruption ◽  
First Trimester ◽  
Free T4 ◽  
Cross Sectional ◽  
Death Rates ◽  
First Trimester Of Pregnancy ◽  
Tsh Levels

Objectives: The prime objective of this study was to evaluate and asses the prevalence and related complications of SCH in pregnant ladies in their 1st trimester of pregnancy in Pakistani population. Study Design: Cross Sectional study. Setting: Department of Medicine, Teaching Hospital, DG Khan, Pakistan. Period: 11th February 2017 to 29th December 2018. Material & Methods: We obtained informed consent from all patients. 457 pregnant ladies having last missed period till 12th week with age group between 18-45 years were included in this study. Samples were collected for T4 (Thyroxine), TSH (Thyroid Stimulating Hormone) and T3 (Triiodothyronine). Patients were followed for their entire pregnancy period.  Adverse events and complications were noted. Results: Out of 457 patients who were included in our study, 169 subjects had TSH levels well above 4.6- 10 mIU/L. 288 subjects were having TSH levels below 4 mIU/L. The overall prevalence of subclinical hypothyroidism (SCH) was found to be 37% in pregnant women during their first trimester of pregnancy. Pregnant women having subclinical hypothyroidism (SCH) were having higher risks of loss of pregnancy, placental abruption and neonatal death rates as compared to euthyroid pregnant women. Conclusion: Our study concludes that overall prevalence of subclinical hypothyroidism (SCH) in Pakistani pregnant women during their first trimester of pregnancy was found to be 37%. Pregnant women having subclinical hypothyroidisms (SCH) were having higher risks of loss of pregnancy, placental abruption and neonatal death rates as compared to euthyroid pregnant women. In the light of these findings we recommend routine screening for TSH, free T3 and free T4 during pregnancy especially during 1st trimester of pregnancy.

scholarly journals Frequency of subclinical hypothyroidism and mean serum TSH level in first trimester of pregnancy.

2021 ◽  
Vol 28 (12) ◽  
pp. 1763-1767
Author(s):  
Fouzia Perveen ◽  
Lubna Ali ◽  
Afshan Hasan
Keyword(s):  
Pregnant Women ◽  
Gestational Age ◽  
Subclinical Hypothyroidism ◽  
Maternal Age ◽  
Age Groups ◽  
First Trimester ◽  
Level Data ◽  
First Trimester Of Pregnancy ◽  
The Mean ◽  
Serum Tsh

Objective: To find out the frequency of subclinical hypothyroidism (SCH) in our pregnant population during 1st Trimester and the mean TSH level in first trimester of pregnancy. Study Design: Cross Sectional Descriptive study. Setting: Dow University Hospital and Dr Ruth KM Pfau CHK. Period: June 2015 to May 2016. Material & Methods: All Pregnant women with <14 weeks gestation were screened for Serum TSH level. Data were recorded after informed consent and institutional ethical approval. Variables recorded were age, parity, gestational age and serum TSH level. Data were analyzed on SPSS version 16. Mean and SD were calculated for quantitative variables ie. Age, parity, gestational age, serum TSH level and serum free T4 level. Mean TSH level according to age group, parity and gestational age groups were determined by applying ANOVA test. Correlation of Serum TSH level with the maternal age, parity and gestational age groups were also assessed by Pearson Correlation test. Significant P-value was taken as <0.05. Results: The frequency of SCH found was 19.35% by taking cut off limit of <2.5 IU/L and 3.55% by taking cut off limit of <4.5 IU/L among total of 310 pregnant women. Mean TSH level was 1.84±1.36 IU/L. The mean maternal age was 27.22 ± 4.43 yrs. while median parity was 1. Mean gestational age of these patients were 9.41 ± 2.748 weeks and out of these 160 (51.61%) were between 4-9 weeks and 150(48.38%) between 10-14 weeks. Majority (74%) of these women belonged to lower middle socioeconomic class. Mean TSH level coorelation between different age groups, parity groups and gestational age groups were found to be insignificant. Conclusion: The prevalence of SCH is not so high and mean TSH level in our population was 1.84 IU/L. But to establish reference range for Pakistani population, further studies in population of different backgrounds and geographical distribution needs to be evaluated.

scholarly journals First trimester thyroid function in pregnant women residing in Saint Petersburg (Russia): reference values and risk of gestational diabetes

2018 ◽  
Vol 21 (1) ◽  
pp. 34-41
Author(s):  
Polina V. Popova ◽  
Ekaterina S. Shilova ◽  
Alexandra S. Tkachuk ◽  
Alexandra V. Dronova ◽  
Anna D. Anopova ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Pregnant Women ◽  
Reference Values ◽  
Subclinical Hypothyroidism ◽  
Reference Interval ◽  
First Trimester ◽  
Specific Reference ◽  
Thyroid Status ◽  
Saint Petersburg ◽  
Increased Risk

Background. Subclinical hypothyroidism during pregnancy and gestational diabetes mellitus (GDM) is known to be associated with maternal and child morbidity. The concept of subclinical dysfunction of the thyroid gland in pregnant women depends on the population-specific and trimester-specific reference values so fixed universal cutoff concentrations for thyroid-stimulating hormone (TSH) that were recommended earlier now are put under the question. Population-specific and trimester-specific reference values have not been defined for pregnant women residing in Saint Petersburg. The data concerning the association of maternal thyroid status with GDM development are controversial. Aims. The aim of the study was to determine the reference values of TSH and free thyroxin (fT4) in the first trimester of pregnancy in women living in St. Petersburg, and to assess the relationship between thyroid status and the risk of subsequent development of GDM. Materials and methods. The levels of TSH, fT4 and thyroid peroxidase antibodies (TPO-Ab) were analyzed in 503 pregnant women before the 14th week of gestation. The women underwent oral glucose tolerance test (OGTT) at 2428 weeks to find out those with GDM. The association between thyroid function, thyroid autoimmunity and the risk of GDM we estimated. Results. The reference values for TSH were 0.07 4.40 mU /L, and for fT4 11.7 20.3 pmol/L. The prevalence of subclinical hypothyroidism in the 503 pregnant women was 16.9% according to the diagnostic criteria of TSH 2.5 mIU / L and 3.8% using our calculated reference interval. Hypothyroxinemia was registered in 5,3% using reference values recommended by diagnostic tests manufacturer and in 2,8% according to our calculated reference interval for fT4. GDM was diagnosed in 23% of women. Logistic regression analysis showed associations of hypothyroxinemia and TPO-Ab-positivity with the increased risk of GDM that remained significant after adjustments on age and body mass index (BMI) [adjusted OR (95% CI) = 7.39 (1.2742.93) for hypothyroxinemia, p=0.026; and adjusted OR (95% CI) = 2.02 (1.014.04) for TPO-Ab-positivity, p=0.047). Conclusions. Reference intervals for first trimester TSH and fT4 have been established for pregnant women living in St. Petersburg. Hypothyroxinemia and TPO-Ab-positivity were associated with the increased risk of GDM.

scholarly journals Mild Anemia May Affect Thyroid Function in Pregnant Chinese Women During the First Trimester

2021 ◽  
Vol 12 ◽  
Author(s):  
Guan-ying Nie ◽  
Rui Wang ◽  
Peng Liu ◽  
Ming Li ◽  
Dian-jun Sun
Keyword(s):  
Pregnant Women ◽  
Thyroid Function ◽  
Normal Control ◽  
Subclinical Hypothyroidism ◽  
First Trimester ◽  
Specific Reference ◽  
American Thyroid Association ◽  
Mild Anemia ◽  
Upper Limit ◽  
Tsh Levels

BackgroundPregnant women are often susceptible to anemia, which can damage the thyroid gland. However, compared with moderate and severe anemia, less attention has been paid to mild anemia. The purpose of this study was to evaluate the effect of mild anemia on the thyroid function in pregnant women during the first trimester.MethodsA total of 1,761 women in the first trimester of their pregnancy were enrolled from Shenyang, China, and divided into mild anemia and normal control groups based on their hemoglobin levels. Thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) levels were compared between the two groups.ResultsThe TSH levels of pregnant women with mild anemia were higher than those of pregnant women without mild anemia (p &lt; 0.05). Normal control women were selected to set new reference intervals for TSH, FT3, and FT4 levels during the first trimester, which were 0.11–4.13 mIU/l, 3.45–5.47 pmol/l, and 7.96–16.54 pmol/l, respectively. The upper limit of TSH 4.13 mU/l is close to the upper limit 4.0 mU/l recommended in the 2017 American Thyroid Association (ATA) guidelines, indicating that exclusion of mild anemia may reduce the difference in reference values from different regions. Mild anemia was related to 4.40 times odds of abnormally TSH levels (95% CI: 2.84, 6.76) and 5.87 increased odds of abnormal FT3 (95% CI: 3.89, 8.85). The proportion of hypothyroidism and subclinical hypothyroidism in patients with mild anemia was higher than that in those without anemia (0.6% vs. 0, p = 0.009; 12.1% vs. 1.9%, p &lt; 0.001). Mild anemia was related to 7.61 times increased odds of subclinical hypothyroidism (95% CI: 4.53, 12.90).ConclusionsMild anemia may affect thyroid function during the first trimester, which highlights the importance of excluding mild anemia confounding when establishing a locally derived specific reference interval for early pregnancy.

Subclinical Hypothyroidism (SCH) in the First Trimester of Pregnancy: A Cross-Sectional Study at a Tertiary Care Hospital

2021 ◽  
Vol 15 (8) ◽  
pp. 1855-1857
Author(s):  
Israr-Ul- Haq ◽  
Junaid Mushtaq ◽  
Atiq Ahmad ◽  
Waqas Mahmood ◽  
Mujtaba Hasan Siddiqui ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Neonatal Death ◽  
Tertiary Care ◽  
First Trimester ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
First Trimester Of Pregnancy

Aim: To evaluate and assess the prevalence along with its related complications of subclinical hypothyroidism in pregnant ladies during the 1st trimester of pregnancy in Pakistani population. Study design: Cross sectional study Place and duration of study: Department of Medicine, Unit-1 of Lahore General Hospital, Lahore, Pakistan from 11th February 2019 to 29th December 2019. Methodology: Four hundred and fifty seven pregnant women with a gestational age up to 12th week with an age group between 18-45 years were included in this study. Blood samples were collected for free triiodothyronine, free thyroxine and thyroid stimulating hormone levels. Patients were regularly followed at an interval of 4 weeks for their entire pregnancy period. Adverse events and complications were noted. Results: One hundred and sixty nine subjects had TSH levels above the normal range i.e., 4.6-10mIU/L. 288 subjects were having TSH below 4 mIU/L levels. The overall prevalence of subclinical hypothyroidism (SCH) was found to be 37% in pregnant women during their first trimester of pregnancy. Pregnant women having subclinical hypothyroidism (SCH) were having higher risks of loss of pregnancy, abruptio placentae and neonatal death rates as compared to euthyroid pregnant women. Conclusion: Higher prevalence of subclinical hypothyroidism (SCH) in the first trimester of pregnancy indicates that these women are at increased risks of loss of pregnancy, placental abruption and neonatal death as compared to euthyroid pregnant women. Keywords: First trimester; pregnancy; subclinical hypothyroidism

scholarly journals Maternal Subclinical Hypothyroidism in the first trimester is not Associated with Gestational Diabetes Mellitus

2019 ◽  
Author(s):  
Ping Li ◽  
Xinjuan Chen ◽  
Jinhui Cui ◽  
Zhaoran Meng ◽  
Jianhui Fan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Subclinical Hypothyroidism ◽  
First Trimester ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Free T4 ◽  
Chi Square ◽  
Tsh Levels

Abstract Background: To explore the association between subclinical hypothyroidism (SCH) during the first trimester and gestational diabetes mellitus (GDM) that was happened later on in our cohort. Methods: A total of 6530 pregnant women who first visited before 13 +6 gestational weeks and accepted routinely prenatal services in the third affiliated hospital of Sun Yat-Sen University from January 2015 to September 2018 were finally met the inclusion criteria and recruited. Thyroid functions (TSH, free T4 (FT4) and TPOAb) were performed at the first visit and a 2h 75-g oral glucose tolerance test was performed between 24-28 weeks. Chi-square test and multivariate logistic regression were used to evaluate the association between SCH and GDM. Results: Though SCH group was divided into subgroups according TPOAb status and TSH levels, the incidence of GDM was no change when compared with the normal group (all P > 0.05). No matter adjusting or not for maternal age, maternal pregestational body max index, parity and educational level, the results showed elevated TSH was not associated GDM (all P > 0.05). TPOAb status also had no effect on the incidence of GDM either before or after adjustment ( P > 0.05). Conclusion: Maternal SCH in the first trimester was not associated with GDM, regardless of the TPOAb status or the TSH levels.

86-LB: Elevated First-Trimester Neutrophil Count Is Associated with the Development of Gestational Diabetes Mellitus in Pregnant Women

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 86-LB
Author(s):  
TIANGE SUN ◽  
FANHUA MENG ◽  
RUI ZHANG ◽  
ZHIYAN YU ◽  
SHUFEI ZANG ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Neutrophil Count ◽  
First Trimester

scholarly journals Antibiotic Prescriptions among China Ambulatory Care Visits of Pregnant Women: A Nationwide Cross-Sectional Study

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 601
Author(s):  
Houyu Zhao ◽  
Mei Zhang ◽  
Jiaming Bian ◽  
Siyan Zhan
Keyword(s):  
Pregnant Women ◽  
Ambulatory Care ◽  
National Level ◽  
Mainland China ◽  
Antibiotic Use ◽  
First Trimester ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Fetal Safety ◽  
First Trimester Of Pregnancy

Background: Antibiotic use in pregnant women at the national level has rarely been reported in China. Objectives: We aimed to investigate antibiotic prescriptions during pregnancy in ambulatory care settings in China. Methods: Data of 4,574,961 ambulatory care visits of pregnant women from October 2014 to April 2018 were analyzed. Percentages of Antibiotic prescriptions by different subgroups and various diagnosis categories and proportions of inappropriate antibiotic prescriptions for different subgroups were estimated. Food and Drug Administration (FDA) pregnancy categories were used to describe the antibiotic prescription patterns. The 95% confidence intervals (CIs) were estimated using the Clopper––Pearson method or Goodman method. Results: Among the 4,574,961 outpatient visits during pregnancy, 2.0% (92,514 visits; 95% CI, 2.0–2.0%) were prescribed at least one antibiotic. The percentage of antibiotic prescriptions for pregnant women aged >40 years was 4.9% (95% CI, 4.7–5.0%), whereas that for pregnant women aged 26–30 years was 1.5% (95% CI, 1.4–1.5%). In addition, percentages of antibiotic prescriptions varied among different trimesters of pregnancy, which were 5.4% (95% CI, 5.3–5.4%) for the visits in the first trimester of pregnancy and 0.5% (95% CI, 0.4–0.5%) in the third trimester of pregnancy. Furthermore, the percentages of antibiotic prescriptions substantially varied among different diagnosis categories and nearly three-quarters of antibiotic prescriptions had no clear indications and thus might be inappropriate. In total, 130,308 individual antibiotics were prescribed; among these, 60.4% (95% CI, 60.0–60.8%) belonged to FDA category B, 2.7% (95% CI, 2.1–3.5%) were classified as FDA category D and 16.8% (95% CI, 16.2–17.4%) were not assigned any FDA pregnancy category. Conclusions: Antibiotic prescriptions in ambulatory care during pregnancy were not highly prevalent in mainland China. However, a substantial proportion of antibiotics might have been prescribed without adequate indications. Antibiotics whose fetal safety has not been sufficiently illustrated were widely used in pregnant women.

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