Neonatal outcome in pregnancy hypotiroidee women

An analysis of real-life data of infants born to mothers with autoimmune thyroiditis: do they need to be followed-up?

BACKGROUND

Infants born to mothers with autoimmune thyroiditis (AT) could be at risk of developing thyroid dysfunction, and maternal anti-thyroid antibodies have been shown to have a clinical impact on offspring. We aimed at evaluating the usefulness of our follow-up intervention protocol in newborns from mothers with AT and to define the most appropriate management for these neonates.

METHODS

89 mothers with AT and their newborns were included. Data on maternal thyroid function and autoimmunity were collected; serum thyroid function and autoimmunity of infants were assessed regularly until normalisation of thyroid stimulating hormone (TSH) and anti-thyroid antibodies, according to the local protocol.

RESULTS

Thyroid auto-antibodies were measured in 38% and in 62% of mothers before and during pregnancy, respectively. Anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) were positive in 97% and 61%, respectively, of the mothers assessed. Anti-TSH receptor antibodies (TRAb) were checked in 18% of the mothers and all were negative. 94% of newborns at first evaluation had positive anti-thyroid antibodies, starting to normalise or decrease from the second month of life. Analysing TSH levels according to the days of postnatal life of collection samples (T1: 30 ± 7 days, T2: 61 ± 9 days, T3: 105 ± 49 days, T4: 135 ± 31 days, T5: 247 ± 64 days), peak TSH levels were found at T4 (4.4 ± 2.2 mU/L), within the cut-off of 6 mU/L. 84% of children maintained a normal thyroid function during follow-up; 12% of infants presented a TSH above 6 mU/L at least in one blood test, showing normalisation during follow-up. Only one infant received replacement therapy for hypothyroidism at 2 months. 91% of the 22 thyroid ultrasounds (US) performed were normal. In those with changes thyroid function normalised anyway.

CONCLUSIONS

Mothers with AT do not seem to deliver newborns at risk of overt hypothyroidism. However, because of the possible negative effects of maternal anti-thyroid antibodies, we underline the importance of monitoring thyroid autoimmunity during pregnancy, including both anti-TG besides anti-TPO antibodies.

Associations of Maternal Serum Iodine Concentration with Obstetric Complications and Birth Outcomes-Longitudinal Analysis Based on the Huizhou Mother-Infant Cohort, South China

This study aimed to explore the temporal associations between maternal serum iodine concentration (SIC) and common pregnancy outcomes in Chinese women. Eligible singleton pregnant women aged 20-34 years were selected, and their fasting blood samples were collected during early (T1, n = 1101) and mid-pregnancy (T2, n = 403) for SIC testing by inductively coupled plasma mass spectrometry. Multivariable linear regression indicated that log₁₀SIC at T1 (β = -0.082), T2 (β = -0.198), and their % change (β = -0.131) were inversely associated with gestational weight gain (GWG, all p < 0.05). Maternal log₁₀SIC at both T1 (β = 0.077) and T2 (β = 0.105) were positively associated with the Apgar score at 1 min (both p < 0.05). Women in the third quartile (Q3) of SIC at T1 had a lower risk of small for gestational age (SGA, OR = 0.405, 95% CI: 0.198-0.829) compared with those in Q4. Restricted cubic spline regression suggested a U-shaped association between SIC and SGA risk, and SIC above 94 μg/L at T1 was the starting point for an increased risk of SGA. The risk of premature rupture of membrane (PROM) increased by 96% (OR = 1.960, 95% CI: 1.010-3.804) in Q4 compared to that in Q1. Our longitudinal data from an iodine-replete region of China indicated that high maternal SIC could restrict GWG and improve Apgar scores at delivery, but might increase the risk of SGA and PROM.

Single Nucleotide Polymorphisms from CSF2, FLT1, TFPI and TLR9 Genes Are Associated with Prelabor Rupture of Membranes

A prelabor rupture of membranes (PROM) and its subtypes, preterm PROM (pPROM) and term PROM (tPROM), are associated with disturbances in the hemostatic system and angiogenesis. This study was designed to demonstrate the role of single nucleotide polymorphisms (SNPs), localized in CSF2 (rs25881), FLT1 (rs722503), TFPI (C-399T) and TLR9 (rs352140) genes, in PROM. A population of 360 women with singleton pregnancy consisted of 180 PROM cases and 180 healthy controls. A single-SNP analysis showed a similar distribution of genotypes in the studied polymorphisms between the PROM or the pPROM women and the healthy controls. Double-SNP TT variants for CSF2 and FLT1 polymorphisms, CC variants for TLR9 and TFPI SNPs, TTC for CSF2, FLT1 and TLR9 polymorphisms, TTT for FLT1, TLR9 and TFPI SNPs and CCCC and TTTC complex variants for all tested SNPs correlated with an increased risk of PROM after adjusting for APTT, PLT parameters and/or pregnancy disorders. The TCT variants for the CSF2, FLT1 and TLR9 SNPs and the CCTC for the CSF2, FLT1, TLR9 and TFPI polymorphisms correlated with a reduced risk of PROM when corrected by PLT and APTT, respectively. We concluded that the polymorphisms of genes, involved in hemostasis and angiogenesis, contributed to PROM.

Nutrition in Reproductive Health: Nutritional Conditioning Factors during Pregnancy and Its Impact on Health

During the gestational period, women need to have optimal health to meet fetal requirements for growth and development. Nutrition is one of the most important factors that can ensure a mother`s health and also that of their offspring. The role of maternal diet, before and during pregnancy, has been associated with adverse birth outcomes and a worsening of maternal health. Medical conditions that are closely related to dietary intake and may affect women before or during pregnancy have also been associated with the appearance of pathology in a newborn. To date, several studies have been carried out in order to identify the role of diet as a factor associated with child physiological and psychological health, both in the short and long term. Educating mothers regarding the influence of maternal dietary intake during pregnancy on infants’ health could represent a simple but effective target for public health policies to improve pregnancy nutrition, and therefore help to avoid newborn diseases through the development.