1
|
Jin D, Yu X, Wang Q, Chen X, Xiao M, Wang H, Cui Y, Lu W, Ge L, Yao Y, Zhou X, Wu J, Jian S, Yang H, Tao Y, Shen Q. A study of the effect of hypothyroidism during pregnancy on human milk quality based on rheological properties. J Dairy Sci 2023:S0022-0302(23)02008-8. [PMID: 38135045 DOI: 10.3168/jds.2023-23900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
Hypothyroidism has been found to have an impact on the nutritional composition of human milk during pregnancy. This study aims to explore the combined influence of rheological properties, macronutrient content, particle size, and the zeta-potential of milk fat globules as well as the composition of milk fat globule membrane (MFGM) proteins on the quality of human milk in gestational hypothyroidism. The study revealed that human milk from hypothyroidism during pregnancy (AHM) was less viscoelastic and stable when compared with normal pregnancy group human milk (NHM). Furthermore, the particle size and macronutrient content of NHM were found to be larger than that of AHM. On the other hand, the zeta-potential of AHM was greater than that of NHM. The SDS-PAGE results disclosed that the composition of MFGM proteins in these 2 groups were generally the same, but the content of AHM was lower than that of NHM. In conclusion, this study confirms that hypothyroidism during pregnancy can have a significant impact on the quality of human milk.
Collapse
Affiliation(s)
- Danping Jin
- Collaborative Innovation Center of Seafood Deep Processing, Zhejiang Province Joint Key Laboratory of Aquatic Products Processing, Institute of Seafood, Zhejiang Gongshang University, Hangzhou 310012, China
| | - Xinyue Yu
- Alberta Institute, Wenzhou Medical University, Wenzhou 325035, China
| | - Qingcheng Wang
- Hangzhou Linping Hospital of Traditional Chinese Medicine, Hangzhou 311199, China
| | - Xi Chen
- Collaborative Innovation Center of Seafood Deep Processing, Zhejiang Province Joint Key Laboratory of Aquatic Products Processing, Institute of Seafood, Zhejiang Gongshang University, Hangzhou 310012, China
| | - Min Xiao
- Hangzhou Linping District Maternal & Child Health Care Hospital, Hangzhou, Zhejiang 311113, China
| | - Haifeng Wang
- Collaborative Innovation Center of Seafood Deep Processing, Zhejiang Province Joint Key Laboratory of Aquatic Products Processing, Institute of Seafood, Zhejiang Gongshang University, Hangzhou 310012, China
| | - Yiwei Cui
- Collaborative Innovation Center of Seafood Deep Processing, Zhejiang Province Joint Key Laboratory of Aquatic Products Processing, Institute of Seafood, Zhejiang Gongshang University, Hangzhou 310012, China
| | - Weibo Lu
- Collaborative Innovation Center of Seafood Deep Processing, Zhejiang Province Joint Key Laboratory of Aquatic Products Processing, Institute of Seafood, Zhejiang Gongshang University, Hangzhou 310012, China
| | - Lijun Ge
- Collaborative Innovation Center of Seafood Deep Processing, Zhejiang Province Joint Key Laboratory of Aquatic Products Processing, Institute of Seafood, Zhejiang Gongshang University, Hangzhou 310012, China
| | - Ying Yao
- Hangzhou Linping District Maternal & Child Health Care Hospital, Hangzhou, Zhejiang 311113, China
| | - Xiaoli Zhou
- Hangzhou Linping District Maternal & Child Health Care Hospital, Hangzhou, Zhejiang 311113, China
| | - Jiahui Wu
- Institute of Seafood, Zhejiang Gongshang University, Hangzhou 310012, China
| | - Shikai Jian
- Institute of Seafood, Zhejiang Gongshang University, Hangzhou 310012, China
| | - Huijuan Yang
- College of Standardization, China Jiliang University, Hangzhou 310018, PR China..
| | - Ye Tao
- Hangzhou Linping District Maternal & Child Health Care Hospital, Hangzhou, Zhejiang 311113, China
| | - Qing Shen
- Department of Clinical Laboratory, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou 324000, China.; Institute of Seafood, Zhejiang Gongshang University, Hangzhou 310012, China..
| |
Collapse
|
2
|
Li P, Cui J, Li L, Chen X, Ouyang L, Fan J, Lin S. Association between isolated maternal hypothyroxinemia during the first trimester and adverse pregnancy outcomes in Southern Chinese women: a retrospective study of 7051 cases. BMC Pregnancy Childbirth 2022; 22:866. [DOI: 10.1186/s12884-022-05194-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
Abstract
Background
The association between isolated maternal hypothyroxinemia (IMH) and adverse pregnancy outcomes is still controversial. This study aimed to evaluate the association between IMH during the first trimester and adverse pregnancy outcomes in southern Chinese women.
Methods
This was a hospital-based, retrospective cohort study. The records of 7051 women, including 1337 IMH women and 5714 euthyroid women who had a singleton pregnancy and accepted routine prenatal service at the Third Affiliated Hospital of Sun Yat-Sen University from January 2015 to September 2018, were extracted from the electronic medical records system in this study. Thyroid functions [thyroid-stimulating hormone (TSH), free thyroxine (fT4) and anti-thyroperoxidase autoantibody (TPO-Ab)] had to be measured before 13 weeks and 6 days of gestation. The chi-square test and multivariate logistic regression analysis were applied to evaluate the association between IMH during the first trimester and adverse pregnancy outcomes.
Results
Prepregnancy obesity [prepregnancy body mass index (preBMI) ≥ 25 kg/m2] was found to be more common in the IMH group (11.2% vs. 6.1%) (P < 0.05). The prevalence of gestational diabetes mellitus (GDM), postpartum haemorrhage (PPH), macrosomia and large for gestational age (LGA) was higher in the IMH group. However, after using multivariate logistic regression analysis to adjust for confounders (maternal age, educational levels and preBMI), only LGA was shown to be associated with an increased risk in IMH women [adjusted OR: 1.27 (95% CI 1.044–1.566)]. The prevalence of preterm delivery (either < 37 or < 34 weeks), gestational hypertension, preeclampsia, placenta previa, placental abruption, premature rupture of membrane (PROM), intrauterine growth restriction (IUGR), polyhydramnios, stillbirth, small for gestational age (SGA) and low Apgar score did not increase.
Conclusion
IMH during the first trimester did not increase any risk of adverse pregnancy outcomes in southern Chinese women except LGA.
Collapse
|
3
|
Sundaram Andra Suryanarayana M, Vellingiri K, Agarwal N SK, Mohan B. Can Early Thyroid Profiling Help Avert Spontaneous Abortions/Early Pregnancy Loss: A Retrospective Study. Cureus 2021; 13:e18003. [PMID: 34667679 PMCID: PMC8516322 DOI: 10.7759/cureus.18003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 12/01/2022] Open
Abstract
Presence of thyroid autoantibodies in euthyroid women can result in various complications such as miscarriages and pre-eclampsia. Women who are hypothyroid have an increased risk of anaemia, infertility, and preterm birth. Spontaneous miscarriages have been reported in association with women with antithyroid antibodies. This can be utilised as a supplementary marker for the mother's immune system failure. The goal of this study was to compare the thyroid profiles of pregnant women who had a normal delivery to those who had a high-risk obstetric history, and to see if early thyroid profiling can help prevent poor pregnancy outcomes. In conclusion, our analysis has demonstrated that women with abnormal values of T4, T3, anti-thyroid peroxidase (TPO), and TSH were associated with fetal demise when compared to women with normal values of T4, T3, anti-TPO, and TSH. Anti-TPO levels were shown to be elevated in women with a poor obstetric history, making early thyroid profiling improve outcomes in pregnancy. Hypothyroidism with increased TSH and anti-TPO levels may have a negative impact on obstetric history, resulting in the loss of an early pregnancy.
Collapse
Affiliation(s)
| | - Kishore Vellingiri
- Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | | | - Bhushan Mohan
- Medicine and Surgery, PSG Institute of Medical Sciences and Research, Coimbatore, IND
| |
Collapse
|
4
|
American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice, Society for Maternal-Fetal Medicine. Indications for Outpatient Antenatal Fetal Surveillance: ACOG Committee Opinion, Number 828. Obstet Gynecol 2021; 137:e177-97. [PMID: 34011892 DOI: 10.1097/AOG.0000000000004407] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
ABSTRACT The purpose of this Committee Opinion is to offer guidance about indications for and timing and frequency of antenatal fetal surveillance in the outpatient setting. Antenatal fetal surveillance is performed to reduce the risk of stillbirth. However, because the pathway that results in increased risk of stillbirth for a given condition may not be known and antenatal fetal surveillance has not been shown to improve perinatal outcomes for all conditions associated with stillbirth, it is challenging to create a prescriptive list of all indications for which antenatal fetal surveillance should be considered. This Committee Opinion provides guidance on and suggests surveillance for conditions for which stillbirth is reported to occur more frequently than 0.8 per 1,000 (the false-negative rate of a biophysical profile) and which are associated with a relative risk or odds ratio for stillbirth of more than 2.0 compared with pregnancies without the condition. Table 1 presents suggestions for the timing and frequency of testing for specific conditions. As with all testing and interventions, shared decision making between the pregnant individual and the clinician is critically important when considering or offering antenatal fetal surveillance for individuals with pregnancies at high risk for stillbirth or with multiple comorbidities that increase the risk of stillbirth. It is important to emphasize that the guidance offered in this Committee Opinion should be construed only as suggestions; this guidance should not be construed as mandates or as all encompassing. Ultimately, individualization about if and when to offer antenatal fetal surveillance is advised.
Collapse
|
5
|
Magnus MC, Morken NH, Wensaas KA, Wilcox AJ, Håberg SE. Risk of miscarriage in women with chronic diseases in Norway: A registry linkage study. PLoS Med 2021; 18:e1003603. [PMID: 33970911 DOI: 10.1371/journal.pmed.1003603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 05/24/2021] [Accepted: 04/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increased risk of miscarriage has been reported for women with specific chronic health conditions. A broader investigation of chronic diseases and miscarriage risk may uncover patterns across categories of illness. The objective of this study was to study the risk of miscarriage according to various preexisting chronic diseases. METHODS AND FINDINGS We conducted a registry-based study. Registered pregnancies (n = 593,009) in Norway between 2010 and 2016 were identified through 3 national health registries (birth register, general practitioner data, and patient registries). Six broad categories of illness were identified, comprising 25 chronic diseases defined by diagnostic codes used in general practitioner and patient registries. We required that the diseases were diagnosed before the pregnancy of interest. Miscarriage risk according to underlying chronic diseases was estimated as odds ratios (ORs) using generalized estimating equations adjusting for woman's age. The mean age of women at the start of pregnancy was 29.7 years (SD 5.6 years). We observed an increased risk of miscarriage among women with cardiometabolic diseases (OR 1.25, 95% CI 1.20 to 1.31; p-value <0.001). Within this category, risks were elevated for all conditions: atherosclerosis (2.22; 1.42 to 3.49; p-value <0.001), hypertensive disorders (1.19; 1.13 to 1.26; p-value <0.001), and type 2 diabetes (1.38; 1.26 to 1.51; p-value <0.001). Among other categories of disease, risks were elevated for hypoparathyroidism (2.58; 1.35 to 4.92; p-value 0.004), Cushing syndrome (1.97; 1.06 to 3.65; p-value 0.03), Crohn's disease (OR 1.31; 95% CI: 1.18 to 1.45; p-value 0.001), and endometriosis (1.22; 1.15 to 1.29; p-value <0.001). Findings were largely unchanged after mutual adjustment. Limitations of this study include our inability to adjust for measures of socioeconomic position or lifestyle characteristics, in addition to the rareness of some of the conditions providing limited power. CONCLUSIONS In this registry study, we found that, although risk of miscarriage was largely unaffected by maternal chronic diseases, risk of miscarriage was associated with conditions related to cardiometabolic health. This finding is consistent with emerging evidence linking cardiovascular risk factors to pregnancy complications.
Collapse
|
6
|
Didier‐Mathon H, Bouchghoul H, Senat M, Young J, Luton D. Prenatal management of fetal goiter alternating between hypothyroidism and hyperthyroidism in a mother with Graves' disease. Clin Case Rep 2021; 9:2281-2284. [PMID: 33936679 PMCID: PMC8077388 DOI: 10.1002/ccr3.4012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
We present a rare documented case with consecutive hypo- and hyperthyroidism during fetal life. First, hypothyroidism was due to transplacental passage of antithyroid drugs. After the mother's thyroidectomy, fetal hyperthyroidism was due to transplacental passage of persistent anti-thyrotropin receptor antibodies. Fetal goiter disappeared after adjusting maternal treatment.
Collapse
Affiliation(s)
- Hortense Didier‐Mathon
- Department of Obstetrics and GynecologyFHU PrematurityBichat Hospital Assistance publique‐Hôpitaux de ParisParis UniversityParisFrance
| | - Hanane Bouchghoul
- Department of Obstetrics and GynecologyAssistance publique‐Hôpitaux de ParisBicêtre HospitalLe Kremlin‐BicêtreFrance
| | - Marie‐Victoire Senat
- Department of Obstetrics and GynecologyAssistance publique‐Hôpitaux de ParisBicêtre HospitalLe Kremlin‐BicêtreFrance
| | - Jacques Young
- Department of Endocrinology and Reproductive MedicineBicêtre HospitalLe Kremlin‐BicêtreFrance
| | - Dominique Luton
- Department of Obstetrics and GynecologyFHU PrematurityBichat Hospital Assistance publique‐Hôpitaux de ParisParis UniversityParisFrance
- INSERM U1016Institut IMAGINEParisFrance
| |
Collapse
|
7
|
Ma C, Li X, Liu L, Cheng X, Xue F, Wu J, Xia L, Yin Y, Wang D, Zou Y, Qiu L, Liu J. Establishment of Early Pregnancy Related Thyroid Hormone Models and Reference Intervals for Pregnant Women in China Based on Real World Data. Horm Metab Res 2021; 53:272-279. [PMID: 33853119 DOI: 10.1055/a-1402-0290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Thyroid hormone reference intervals are crucial for diagnosing and monitoring thyroid dysfunction during early pregnancy, and the dynamic change trend of thyroid hormones during pregnancy can assist clinicians to assess the thyroid function of pregnant women. This study aims to establish early pregnancy related thyroid hormones models and reference intervals for pregnant women. We established two derived databases: derived database* and derived database#. Reference individuals in database* were used to establish gestational age-specific reference intervals for thyroid hormones and early pregnancy related thyroid hormones models for pregnant women. Individuals in database# were apparently healthy non-pregnant women. The thyroid hormones levels of individuals in database# were compared with that of individuals in database* using nonparametric methods and the comparative confidence interval method. The differences in thyroid stimulating hormone and free thyroxine between early pregnant and non-pregnant women were statistically significant (p<0.0001). The reference intervals of thyroid stimulating hormone, free thyroxine and free triiodothyronine for early pregnant women were 0.052-3.393 μIU/ml, 1.01-1.54 ng/dl, and 2.51-3.66 pg/ml, respectively. Results concerning thyroid stimulating hormone and free thyroxine reference intervals of early pregnancy are comparable with those from other studies using the same detection platform. Early pregnancy related thyroid hormones models showed various change patterns with gestational age for thyroid hormones. Early pregnancy related thyroid hormones models and reference intervals for pregnant women were established, so as to provide accurate and reliable reference basis for the diagnosing and monitoring of maternal thyroid disfunction in early pregnancy.
Collapse
Affiliation(s)
- Chaochao Ma
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Xiaoqi Li
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Lixin Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Xinqi Cheng
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Fang Xue
- Department of Epidemiology and Biostatistics, School of Basic Medicine Peking Union Medical College, Beijing, P. R. China
| | - Jie Wu
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Liangyu Xia
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Yicong Yin
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Danchen Wang
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Yutong Zou
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Ling Qiu
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Juntao Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| |
Collapse
|
8
|
Abstract
The purpose of this study was to explore the impact of maternal thyroid hormone dysfunction in late pregnancy on birth outcomes in a Chinese population. We retrospectively examined hospitalisation records and laboratory data between April 2016 and March 2017 and obtained results from 11,564 consecutive pregnant women with singleton births in which serum thyroid hormone had been examined together with birth outcomes. We assessed the association between maternal thyroid level and dysfunction with adverse birth outcomes based on regression analysis. Hyperthyroidism was associated with an increased risk of preterm birth (PTB, adjusted OR: 2.41, 95% CI: 1.83-3.17) and hypothyroidism was associated with an increased risk of small for gestational age (SGA, adjusted OR: 1.56, 95% CI: 1.10-2.22), while hyperthyroxinaemia was associated with a decreased risk of large for gestational age (LGA, adjusted OR: 0.64, 95% CI: 0.45-0.90). In addition, compared to women with normal FT3 and TSH (≥the 5th and ≤the 95th percentiles), women with high free triiodothyronine (FT3 >the 95th percentile) and low thyroid-stimulating hormone (TSH <the 95th percentile) had a 4.02- fold higher risk of PTB (95% CI: 2.05-7.88), and women with low FT3 and high TSH had a 4.22- fold greater risk of SGA (95% CI: 1.59-11.23). Our study supports associations between multiple types of maternal thyroid dysfunction in late pregnancy and adverse birth outcomes.
Collapse
Affiliation(s)
- Xiaosong Yuan
- Department of Medical Genetics, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Jing Wang
- Department of Medical Genetics, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Yanfang Gao
- Department of laboratory medicine, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Huiyan Wang
- Department of Obstetrics and Gynecology, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Bin Yu
- Department of Medical Genetics, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| |
Collapse
|
9
|
Lecorguillé M, Léger J, Forhan A, Cheminat M, Dufourg MN, Heude B, Charles MA. Pregnancy outcomes in women with preexisting thyroid diseases: a French cohort study. J Dev Orig Health Dis 2021; 12:704-13. [PMID: 33300489 DOI: 10.1017/S2040174420001051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Women with thyroid diseases at the beginning of pregnancy may have suboptimal thyroid hormone levels because of potential difficulties in compensating for the physiological thyroid hormone changes occurring in pregnancy. Our objective was to study the association between preexisting thyroid diseases, pregnancy complications, and neonatal anthropometry. In total, 16,395 women from the ELFE French longitudinal birth cohort were included, and 273 declared pre-pregnancy thyroid diseases. Associations were investigated with multivariable regression models, with adjustment for relevant potential confounders. Body mass index (BMI) was additionally adjusted for in a second stage. As compared with other women, women with pre-pregnancy thyroid diseases were more frequently obese (19.6% vs. 9.8%) and had greater odds of gestational diabetes development (odds ratio [OR] = 1.58 [95% confidence interval [CI] 1.08, 2.30]) or had undergone treatment for infertility (OR = 1.57 [95% CI 1.07, 2.31]). After adjustment for BMI, the association with gestational diabetes was no longer significant (OR = 1.27 [95% CI 0.86, 1.88]). After excluding women with another medical history, those with pre-pregnancy thyroid diseases had increased odds of premature rupture of membranes (OR = 1.51 [95% CI 1.01, 2.25]). Children born from mothers with hypothyroidism before conception due to a disease or as a potential side effect of treatment had a smaller head circumference at birth than other children (β = -0.23 [95% CI -0.44, -0.01] cm). In conclusion, pre-pregnancy thyroid diseases were associated with risk of infertility treatment, gestational diabetes, and premature rupture of membranes. The association between history of hypothyroidism and moderate adverse effects on fetal head circumference growth needs replication.
Collapse
|
10
|
Qin Q, Yang M, Ke W, Zhao J, Ding H. Serum cystatin C is closely associated with euthyroid Hashimoto's thyroiditis in adult female Chinese patients. J Int Med Res 2020; 48:300060520952973. [PMID: 32867566 PMCID: PMC7469752 DOI: 10.1177/0300060520952973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective The aim of our study was to explore the association between serum cystatin C (CysC) and euthyroid Hashimoto’s thyroiditis. Methods There were 119 female euthyroid Hashimoto’s thyroiditis patients and 225 healthy controls who were recruited. Serum CysC, thyroid function, thyroid autoantibodies, fasting glucose, liver enzymes, and lipid profile were determined. Clinical parameters were compared between two groups. Results Serum CysC levels were significantly higher in euthyroid Hashimoto’s thyroiditis patients compared with controls. In the lowest, middle, and highest tertile groups of CysC, the percentage of Hashimoto’s thyroiditis was 15.9%, 34.2%, and 53.5%, respectively. The percentage of Hashimoto’s thyroiditis was significantly higher in the highest tertile than in the lowest and middle tertiles. Spearman’s correlation analysis showed that serum CysC levels were negatively correlated with free triiodothyronine (FT3), and positively correlated with serum thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb). Logistic regression analysis showed that serum CysC was independently related to the status of euthyroid Hashimoto’s thyroiditis. Conclusions The present study shows the first evidence suggesting that serum CysC levels are positively correlated with TPOAb and TGAb. Serum CysC might underlie the pathophysiologic features of euthyroid Hashimoto’s thyroiditis.
Collapse
Affiliation(s)
- Qiaojing Qin
- Department of Nephrology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Min Yang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Wencai Ke
- Department of Clinical Laboratory Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Jinying Zhao
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Heyuan Ding
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| |
Collapse
|
11
|
Abstract
Thyroid disease can significantly impact the pregnant woman and her child. Human and animal studies have firmly linked overt hypothyroidism and overt hyperthyroidism to miscarriage, preterm delivery and other adverse pregnancy outcomes. Overt hypothyroidism and overt hyperthyroidism affect 1% of all pregnancies. Treatment is widely available, and if detected early, results in decreased rates of adverse outcomes. Universal screening for thyroid disease in pregnancy can identify patients with thyroid disease requiring treatment, and ultimately decrease rates of complications. Universal screening is cost-effective compared to the currently accepted practice of targeted screening and may even be cost-saving in some healthcare systems. Targeted screening, which is recommended by most professional associations, fails to detect a large proportion of pregnant women with thyroid disease. In fact, an increasing number of providers are performing universal screening for thyroid disease in pregnancy, contrary to society guidelines. Limited evidence concerning the impact of untreated and treated subclinical disease and thyroid autoimmunity has distracted from the core rationale for universal screening - the beneficial impact of detecting and treating overt thyroid disease. Evidence supporting universal screening for overt disease stands independently from that of subclinical and autoimmune disease. The time to initiate universal screening is now.
Collapse
Affiliation(s)
- Alex Stagnaro-Green
- Department of Medicine, Obstetrics & Gynecology and Medical Education, University of Illinois College of Medicine at Rockford, 1601 Parkview Avenue, Rockford, IL 61107, USA.
| | - Allan Dong
- Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Chicago, 820 S. Wood Street, M/C 808, Chicago, IL 60612, USA.
| | - Mary D Stephenson
- Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Chicago, 820 S. Wood Street, M/C 808, Chicago, IL 60612, USA.
| |
Collapse
|
12
|
Gui J, Xu W, Zhang J. Association between thyroid dysfunction and perinatal outcomes in women with gestational hypertension: a retrospective study. BMC Pregnancy Childbirth 2020; 20:119. [PMID: 32075602 PMCID: PMC7031863 DOI: 10.1186/s12884-020-2805-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/11/2020] [Indexed: 11/22/2022] Open
Abstract
Background Previous studies showed that thyroid dysfunction in women with gestational hypertension could negatively affect maternal and fetal outcomes. In this study, we aimed to investigate whether thyroid dysfunction assessed in the second half trimester contributed to neonatal outcomes of pregnancy in different subtypes of gestational hypertension disease. Methods We performed a retrospective case-control study and collected data from 135 singleton pregnant women with gestational hypertension disease and their offspring who delivered in Renmin Hospital of Wuhan University from January 2015 to June 2017. We classified the patients based on the severity of the preeclampsia into three groups: pregnant induced hypertension (PIH), mild preeclampsia (MPE) and severe preeclampsia (SPE). Based on the onset time of preeclampsia, we classified the patients into PIH, early onset preeclampsia (EPE) and late onset preeclampsia. Demographic data and levels of thyroid hormones, as well as the adverse maternal and neonatal outcomes were collected from Electronic Medical Records. Logistic regression was used to estimate the associations between thyroid dysfunction and neonatal outcomes in these patients. Results Gestational weeks and neonatal birthweight were significantly lower, while incidence of preterm birth was significantly higher in the SPE and EPE groups than those in the PIH group (P < 0.001). Thyroid dysfunction was more frequent in the SPE group than in the MPE group (P = 0.01). Incidences of both preterm birth and low birth weight were significantly higher in patients with thyroid dysfunction (P = 0.008, P = 0.047 respectively). After adjustment, both severity of gestational hypertension (OR = 4.360, 95%CI [2.050, 9.271], P < 0.001; OR = 4.023, 95%CI [1.933, 8.372], P < 0.001) and thyroid dysfunction (OR = 3.011, 95%CI [1.248, 7.262], P = 0.014; OR = 11.306, 95%CI [1.040, 122.889], P = 0.046) were associated with higher risk of preterm birth and low birth weight, while the onset time of preeclampsia (OR = 0.031, 95%CI [0.009, 0.110], P < 0.001; OR = 0.097, 95%CI [0.033, 0.282], P < 0.001) was negatively associated with the risk of preterm birth and low birth weight. Conclusion Severe and early onset preeclampsia, as well as thyroid dysfunction are associated with higher risk of preterm birth and low neonatal birth weight. Therefore, our data suggest that monitoring thyroid hormones in women with preeclampsia might help to predict adverse neonatal outcomes.
Collapse
Affiliation(s)
- Juan Gui
- Dept. of Reproductive center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan, 430060, China. .,Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan, China.
| | - Wangming Xu
- Dept. of Reproductive center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan, 430060, China.,Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan, China
| | - Jie Zhang
- Dept. of Reproductive center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan, 430060, China
| |
Collapse
|
13
|
Abstract
The current study aimed to analyze the effects of thyroid diseases on pregnancy outcomes and investigate the effects of levothyroxine (L-T4) tablets in the treatment of hypothyroidism. The current study determined the prevalence of thyroid diseases using two diagnostic criteria, the prevalence of thyroid diseases among pregnant women recruited in 2010 and 2014 were initially determined by the 2011 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum (2011 ATA Guidelines). Subjects were categorized into six groups: Normal, hypothyroxinemia, hypothyroidism, subclinical hypothyroidism (SCH), hyperthyroidism and subclinical hyperthyroidism. L-T4 was administered in the thyroid-insufficient groups and the prevalence rates of these categories were obtained using the diagnostic criteria from the 2011 ATA Guidelines and the 2012 Chinese Guidelines for the Diagnosis and Treatment of Thyroid Disease During Pregnancy and Postpartum (2012 Chinese Guidelines). The results of the current study demonstrated that the screening of thyroid function was significantly increased in 2014 (thyroid dysfunction rate, 82.4% vs. 29.1%; P<0.001). Hypothyroxinemia, hypothyroidism, SCH, hyperthyroidism and subclinical hyperthyroidism increased the likelihood of certain adverse outcomes and complications. L-T4 decreased the odds of gestational hypertension, premature birth and low birth weight or very low birth weight in the hypothyroidism group. A statistically significant difference was identified between thyroid disease incidences as determined by the 2011 ATA Guidelines 2012 Chinese Guidelines. In conclusion, abnormal thyroid levels increased the odds of adverse pregnancy outcomes, L-T4 administration improved pregnancy outcomes and the 2012 Chinese Guidelines may provide a better reference for Chinese pregnant women with subclinical hyperthyroidism.
Collapse
Affiliation(s)
- Min Zhou
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Min Wang
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Juming Li
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China.,Department of Endocrinology, Tianjin Fifth Central Hospital, Tianjin 300450, P.R. China
| | - Xiaohui Luo
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Minxiang Lei
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| |
Collapse
|
14
|
Cathey AL, Watkins D, Rosario ZY, Vélez C, Alshawabkeh AN, Cordero JF, Meeker JD. Associations of Phthalates and Phthalate Replacements With CRH and Other Hormones Among Pregnant Women in Puerto Rico. J Endocr Soc 2019; 3:1127-1149. [PMID: 31093596 PMCID: PMC6510018 DOI: 10.1210/js.2019-00010] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/05/2019] [Indexed: 11/25/2022] Open
Abstract
CONTEXT Phthalates are endocrine-disrupting chemicals that may be associated with adverse birth outcomes. Dysregulation of maternal endocrine homeostasis could be a possible biological pathway between phthalates and birth outcomes. OBJECTIVE Examine associations between 19 maternal urinary phthalate or phthalate replacement metabolites and 9 serum hormones measured over two time points during pregnancy. DESIGN Longitudinal study conducted in the PROTECT pregnancy cohort. SETTING Puerto Rico. PATIENTS Six hundred seventy-seven women in the first trimester of pregnancy. MAIN OUTCOME MEASURES SERUM CRH, estriol, SHBG, progesterone, TSH, total T3, free T4, total T4, and testosterone. RESULTS T3 was significantly associated with most metabolites. CRH was inversely associated with mono carboxyisononyl phthalate [MCNP; percent change (%Δ), -4.08; 95% CI, -7.24, -0.804], mono-3-carboxypropyl phthalate (MCPP; %Δ, -5.25; 95% CI, -8.26, -2.14), mono-2-ethyl-5-carboxypentyl phthalate (MECPP; %Δ, -18.4; 95% CI, -30.4, -4.37), mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP; %Δ, -13.4; 95% CI, -22.7, -2.92), and mono-2-ethyl-5-oxohexyl phthalate (MEOHP; %Δ, -12.7; 95% CI, -22.2, -2.20). Positive associations were found between numerous phthalate metabolites and free T4, T4, and the T3/T4 ratio. Testosterone was positively associated with mono hydroxybutyl phthalate (MHBP; %Δ, 4.71; 95% CI, 0.27, 9.35) and inversely associated with monoethyl phthalate (MEP; %Δ, -14.5; 95% CI, -24.3, -3.42), and relationships with MCNP and mono carboxyisooctyl phthalate (MCOP) were significantly modified by study visit. Finally, an inverse association was found between mono-2-ethyl-5-hydrohexyl terephthalate (MEHHTP), a terephthalate metabolite, and progesterone at visit 3 only (%Δ, -13.1; 95% CI, -22.3, -2.75). CONCLUSIONS These results indicate that exposure to phthalates may differentially impact the maternal endocrine system at different points during pregnancy, and that exposures to phthalate replacement chemicals may be particularly important to consider in future human health studies.
Collapse
Affiliation(s)
- Amber L Cathey
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Deborah Watkins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Zaira Y Rosario
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Carmen Vélez
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | | | - José F Cordero
- College of Public Health, Athens, University of Georgia, Athens, Georgia
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| |
Collapse
|
15
|
Li P, Lin S, Li L, Cui J, Zhou S, Fan J. Effect of mildly elevated thyroid-stimulating hormone during the first trimester on adverse pregnancy outcomes. BMC Endocr Disord 2018; 18:64. [PMID: 30208865 PMCID: PMC6134553 DOI: 10.1186/s12902-018-0294-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 09/03/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To investigate the effect of a mildly elevated thyroid-stimulating hormone (TSH) concentration between 2.5 and 4.0 mIU/L during the first trimester on pregnancy outcomes in thyroid peroxydase antibody (TPOAb)-negative pregnant women. METHODS A total of 1858 pregnant women who were TPOAb-negative before 13+ 6 gestational weeks, received regular prenatal services, and delivered in the third affiliated hospital of Sun Yat-Sen University were recruited from June 2016 to June 2017. Measurements of thyroid function (TSH, free T4 [FT4] and TPOAb) and adverse pregnancy outcomes were assessed and recorded. RESULTS Among the 1858 study participants, the 97.5th percentile for TSH was 3.76 mIU/L, and 142 women (7.6%) had mildly elevated TSH levels between 2.5 and 4.0 mIU/L. No differences in the incidence of adverse pregnancy outcomes were observed between patients with a mildly elevated TSH level and those with a normal TSH level (< 2.5 mIU/L). CONCLUSION A mildly elevated TSH concentration (2.5-4.0 mIU/L) during the first trimester of pregnancy in TPOAb-negative women was not associated with adverse pregnancy outcomes in our study population. Accordingly, it may be possible to raise the upper limit of the healthy TSH reference range for pregnant women.
Collapse
Affiliation(s)
- Ping Li
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe road, Guangzhou, 510630 China
| | - Shuo Lin
- Department of Endocrinology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ling Li
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe road, Guangzhou, 510630 China
| | - Jinhui Cui
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe road, Guangzhou, 510630 China
| | - Shuisheng Zhou
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe road, Guangzhou, 510630 China
| | - Jianhui Fan
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe road, Guangzhou, 510630 China
| |
Collapse
|
16
|
Shinohara DR, Santos TDS, de Carvalho HC, Lopes LCB, Günther LSA, Aristides SMA, Teixeira JJV, Demarchi IG. Pregnancy Complications Associated With Maternal Hypothyroidism: A Systematic Review. Obstet Gynecol Surv 2018; 73:219-30. [DOI: 10.1097/ogx.0000000000000547] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
17
|
Pakdel R, Hadjzadeh H, Sadegh MM, Hosseini M, Emami B, Hadjzadeh MAR. The Effects of Hydroalcoholic Extract of Nigella sativa Seeds on Serum Estradiol and Prolactin Levels and obstetric Criteria due to Hypothyroidism in Rat. Adv Biomed Res 2017; 6:166. [PMID: 29387677 PMCID: PMC5767798 DOI: 10.4103/2277-9175.221860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The aim of this study was investigation of the effects of Nigella sativa (NS) seeds on hypothyroid pregnant rats and their progenies. Materials and Methods: Hypothyroidism was induced by propylthiouracil (PTU) 0.03% in drinking water. Female rats were divided into seven groups: control, PTU, PTU-NS (100, 200, and 400 mg/kg), and NS (100 and 400 mg/kg). All treatments were done 20 days before mating and during pregnancy. The weight of rat dams and progenies, number of progenies and serum T4, estradiol and prolactin (PRL) levels in rat dams were measured for all groups. Results: Serum T4 in all PTU-NS groups before mating was significantly increased versus PTU group. Body weight of rat dams before mating in all groups of PTU-NS was increased versus PTU group by P < 0.001, P < 0.05, and P < 0.001, respectively and in NS 100 and NS 400 was increased versus control group (P < 0.001). The number of offspring was significantly decreased in PTU and PTU-NS versus control group. The weight of progenies in NS 400 was higher than control group (P < 0.001) and was increased in PTU-NS 200 and PTU-NS 400 versus PTU group by P < 0.001 and P < 0.05, respectively. Serum PRL level in rat dams in control, PTU, and PTU-NS groups were not statistically different between groups but significantly increased in NS 400 group when compared to control group. Estradiol levels were not significantly different in rat dams at 5 days after delivery. Conclusion: These results demonstrated that feeding of rat dams with NS extract before mating has positive protective effects on progenies. These effects may be due to antioxidant properties of NS in reducing oxidative stress and thyroid damages induced by PTU.
Collapse
Affiliation(s)
- Roghayeh Pakdel
- Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossien Hadjzadeh
- Department of Clinical Science, Veterinary Medicine Faculty, Islamic Azad University, Garmsar Branch, Garmsar, Iran
| | - Majid Mohammad Sadegh
- Department of Clinical Science, Veterinary Medicine Faculty, Islamic Azad University, Garmsar Branch, Garmsar, Iran
| | - Mahmoud Hosseini
- Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Neurocognitive Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahman Emami
- Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mousa-Al-Reza Hadjzadeh
- Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Neurocognitive Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
18
|
Parizad Nasirkandy M, Badfar G, Shohani M, Rahmati S, YektaKooshali MH, Abbasalizadeh S, Soleymani A, Azami M. The relation of maternal hypothyroidism and hypothyroxinemia during pregnancy on preterm birth: An updated systematic review and meta-analysis. Int J Reprod Biomed 2017. [DOI: 10.29252/ijrm.15.9.543] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
19
|
Aktaş A, Pekkolay Z. Thyroid Diseases and Treatment in Pregnancy. J Clin Exp Invest 2016. [DOI: 10.5799/jcei.328705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
20
|
Chen X, Jin B, Xia J, Tao X, Huang X, Sun L, Yuan Q. Effects of Thyroid Peroxidase Antibody on Maternal and Neonatal Outcomes in Pregnant Women in an Iodine-Sufficient Area in China. Int J Endocrinol 2016; 2016:6461380. [PMID: 26884759 PMCID: PMC4738937 DOI: 10.1155/2016/6461380] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 12/11/2022] Open
Abstract
Purposes. To evaluate the effects of thyroid peroxidase antibodies (TPOAb) on maternal and neonatal adverse outcomes in pregnant women. Methods. 208 pregnant women at 24-28 weeks were divided into two groups, TPOAb-positive and TPOAb-negative groups. Thyroid function and TPOAb were determined in all subjects until 12 months postpartum. Levothyroxine was supplemented to maintain euthyroid with periodical checking of thyroid functions. The prevalence of postpartum thyroiditis (PPT), placenta previa, placental abruption, premature rupture of membrane, postpartum haemorrhage, polyhydramnios, oligohydramnios, preterm birth, low birth weight, congenital hypothyroidism, and neonatal diseases were observed in two groups. Results. Of all women, 11.54% had a PPT. The prevalence of PPT was significantly higher in TPOAb-positive than TPOAb-negative group (42.31% versus 7.14%, P < 0.001), with 45.46% and 53.85% of PPT happening at 6 weeks postpartum in TPOAb-positive and TPOAb-negative groups. The incidence of polyhydramnios was significantly higher in TPOAb-positive than TPOAb-negative group (15.38% versus 2.74%, P = 0.02). Conclusion. Pregnant women with TPOAb-positive had increased risk of PPT, predominantly happening at 6 weeks postpartum. TPOAb was associated with increased incidence of polyhydramnios and the underlying mechanisms required further investigation. Earlier screening of thyroid function during pregnancy and postpartum was warranted in our region.
Collapse
Affiliation(s)
- Xi Chen
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Bai Jin
- Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jun Xia
- Department of Endocrinology and Metabolism, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou 215000, China
| | - Xincheng Tao
- Department of Nutrition, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiaoping Huang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Lu Sun
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Qingxin Yuan
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- *Qingxin Yuan:
| |
Collapse
|
21
|
Toth B, Würfel W, Bohlmann MK, Gillessen-Kaesbach G, Nawroth F, Rogenhofer N, Tempfer C, Wischmann T, von Wolff M. Recurrent Miscarriage: Diagnostic and Therapeutic Procedures. Guideline of the DGGG (S1-Level, AWMF Registry No. 015/050, December 2013). Geburtshilfe Frauenheilkd 2015; 75:1117-1129. [PMID: 26997666 DOI: 10.1055/s-0035-1558299] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Purpose: Official guideline coordinated and published by the German Society of Gynecology and Obstetrics (DGGG). Aim of the guideline was to standardize the diagnosis and treatment of patients with recurrent miscarriage (RM). Recommendations were proposed, based on the current national and international literature and the experience of the involved physicians. Consistent definitions, objective assessments and standardized therapy were applied. Methods: Members of the different involved societies developed a consensus in an informal process based on the current literature. The consensus was subsequently approved by the heads of the scientific societies. Recommendations: Recommendations for the diagnosis and treatment of patients with RM were compiled which took the importance of established risk factors such as chromosomal, anatomical, endocrine, hemostatic, psychological, infectious and immunological disorders into consideration.
Collapse
Affiliation(s)
- B Toth
- Abteilung für Gynäkologische Endokrinologie und Fertilitätsstörungen, Universitätsfrauenklinik Heidelberg, Heidelberg
| | - W Würfel
- Kinderwunsch Centrum München-Pasing, München
| | - M K Bohlmann
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Mannheim, Mannheim
| | | | - F Nawroth
- Facharzt-Zentrum für Kinderwunsch, Pränatale Medizin, Endokrinologie und Osteologie, Hamburg
| | - N Rogenhofer
- Hormon und Kinderwunschzentrum der Ludwig-Maximilians-Universität München, München
| | - C Tempfer
- Universitätsfrauenklinik der Ruhr-Universität Bochum, Marienhospital Herne, Herne
| | - T Wischmann
- Institut für Medizinische Psychologie im Zentrum für Psychosoziale Medizin des Universitätsklinikums Heidelberg, Heidelberg
| | - M von Wolff
- Inselspital, Universitätsfrauenklinik, Abteilung Gynäkologische Endokrinologie und Reproduktionsmedizin, Bern, Switzerland
| |
Collapse
|
22
|
Munoz JL, Kessler AA, Felig P, Curtis J, Evans MI. Sequential Amniotic Fluid Thyroid Hormone Changes Correlate with Goiter Shrinkage following in utero Thyroxine Therapy. Fetal Diagn Ther 2015; 39:222-7. [PMID: 26314950 DOI: 10.1159/000437367] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/30/2015] [Indexed: 11/19/2022]
Abstract
Several isolated reports of fetal goiter treatment have shown limited generalizability of approaches and provide no real guidance for optimal timing, dosages, and treatment strategies. Graves' disease accounts for >60% of these cases. Maternal treatments of hyperthyroidism include antithyroid medications such as methimazole and more commonly propylthiouracil (PTU). Here, our management of a patient with a fetal thyroid goiter from maternal exposure to PTU diagnosed at 23.6 weeks' gestation and the management of other cases allow us propose a general strategy for treatment. Intrauterine therapy with 200 and then 400 μg of levothyroxine (3 weeks apart) showed an 85% reduction in fetal thyroid goiter volume. We collected amniotic fluid samples at the time of treatments and assayed thyroid hormones and associated antibodies which closely reflected the changes in thyroid goiter mass volume. Our observations suggest a weekly or biweekly therapeutic intervention schedule. Utilizing both goiter size as well as a novel approach in using amniotic fluid hormone levels to monitor therapy efficacy might improve the quality of treatments. Only with a standardized approach and collection of amniotic fluid thyroid panels do we have the opportunity to develop the database required to determine the number and timing of treatments needed.
Collapse
Affiliation(s)
- Jessian L Munoz
- Fetal Medicine Foundation of America and Comprehensive Genetics, PLLC, New York, N.Y., USA
| | | | | | | | | |
Collapse
|
23
|
Brabant G, Peeters RP, Chan SY, Bernal J, Bouchard P, Salvatore D, Boelaert K, Laurberg P. Management of subclinical hypothyroidism in pregnancy: are we too simplistic? Eur J Endocrinol 2015; 173:P1-P11. [PMID: 25650404 DOI: 10.1530/eje-14-1005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/03/2015] [Indexed: 01/09/2023]
Abstract
Guideline advice of many societies on the management of subclinical hypothyroidism in pregnancy suggests treatment when TSH serum levels exceed 2.5 mU/l. Justification of this procedure is based on limited experience, mainly from studies carried out in patients with positive thyroid-specific antibodies and higher TSH levels that classically define the condition in the non-pregnant state. Taking into account a lack of clear understanding of the regulation of thyroid hormone transport through the utero-placental unit and in the absence of foetal markers to monitor the adequacy of thyroxine treatment, this review attempts to discuss currently available data and suggests a more cautious approach.
Collapse
Affiliation(s)
- Georg Brabant
- Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hos
| | - Robin P Peeters
- Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Shiao Y Chan
- Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Juan Bernal
- Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hos
| | - Philippe Bouchard
- Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Domenico Salvatore
- Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Kristien Boelaert
- Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Peter Laurberg
- Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| |
Collapse
|
24
|
Léger J, dos Santos S, Larroque B, Ecosse E. Pregnancy outcomes and relationship to treatment adequacy in women treated early for congenital hypothyroidism: a longitudinal population-based study. J Clin Endocrinol Metab 2015; 100:860-9. [PMID: 25423569 DOI: 10.1210/jc.2014-3049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Untreated hypothyroidism is associated with a higher risk of adverse obstetric and neonatal outcomes. Pregnancy complications have yet to be evaluated in patients treated early for congenital hypothyroidism (CH). OBJECTIVE This study aimed to investigate pregnancy outcomes and their determinants in a population-based registry of young adult women with CH. SETTING AND DESIGN In total, 1748 subjects were diagnosed with CH in the first 10 years after the introduction of neonatal screening in France; 1158 of these subjects completed a questionnaire on fecundity at a mean age of 25.3 years. We analyzed all declared singleton pregnancies ending after greater than 22 weeks of gestation before the initial survey (n = 207 pregnancies) and in the 3 years following the initial survey (prospective study, n = 174 pregnancies). The reference group comprised 7245 subjects from the French National Perinatal Survey. MAIN OUTCOME MEASURES Pregnancy outcomes. Serum TSH concentrations and thyroid hormone requirements. RESULTS In both the overall and prospective analyses, CH was associated with gestational hypertension, emergency cesarean delivery, induced labor for vaginal delivery, and prematurity. For the prospective population with CH, the adjusted odds ratios (aOR) (95% confidence interval [CI]) were 2.19 (1.26-3.81), 1.88 (1.17-3.02), 1.58 (1.12-2.24), and 1.85 (1.06-3.25), respectively. TSH concentrations at least 10 mIU/l during the first 3 or 6 months of pregnancy were associated with a higher risk of preterm delivery (aOR, 5.6; 95% CI, 1.6-20.0) and fetal macrosomia (aOR, 4.5; 95% CI, 1.03-20.1), respectively, whereas no such relationship was observed for TSH concentrations of 5.0-9.9 mIU/l. CONCLUSION CH may result in adverse pregnancy outcomes. These nationwide data suggest that better thyroid disease management is required, particularly during the first two trimesters of pregnancy, together with vigilant monitoring.
Collapse
Affiliation(s)
- Juliane Léger
- Assistance Publique-Hôpitaux de Paris (J.L., S.d.S., E.E.), Hôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, F-75019 Paris, France; Université Paris Diderot (J.L.), Sorbonne Paris Cité, F-75019 Paris, France; Institut National de la Santé et de la Recherche Médicale (J.L.), U1141 Paris, France; Clinical Epidemiology and Research Unit (B.L.), Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 75019 Paris, France; Institut National de la Santé et de la Recherche Médicale (B.L.), UMR S953, Epidemiological Research on Perinatal Health and Women's and Children's Health, 75019 Paris, France
| | | | | | | |
Collapse
|
25
|
Moncayo R, Zanon B, Heim K, Ortner K, Moncayo H. Thyroid function parameters in normal pregnancies in an iodine sufficient population. BBA Clin 2015; 3:90-5. [PMID: 26674060 PMCID: PMC4661549 DOI: 10.1016/j.bbacli.2014.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/27/2014] [Accepted: 12/29/2014] [Indexed: 01/08/2023]
Abstract
Background The aim of this retrospective observational study was to describe thyroid function parameters (fT3, fT4 and TSH) in the course of normal pregnancies. Methods Data were obtained between 2006 and 2007 at the University Hospital in Innsbruck, Austria. The starting point was the identification of women who had had a normal birth as recorded in the birth registry of Tyrol. Thyroid function parameters were determined using methods implemented at the Department of Nuclear Medicine in Innsbruck. Results The fT3 and fT4 values were normally distributed. Grouping the results by trimester revealed the following values: 4.93 ± 0.59, 4.54 ± 0.48, and 4.27 ± 0.45 pmol/l for fT3; and 15.23 ± 2.43, 13.79 ± 1.99, and 13.32 ± 0.2.01 pmol/l for fT4, respectively. The values corresponding to the 10th-percentile were 3.9 pmol/l for fT3 and 11.3 pmol/l for fT4, respectively. TSH values showed a typical left skewed distribution, thus the mean values were calculated after log transformation of the data. The corresponding mean trimestral values for TSH were 1.46 ± 1.29, 1.68 ± 1.23, and 1.70 ± 2.22 mIU/l, respectively. Conclusion In an iodine sufficient population, thyroid function parameters in normal pregnancies do not differ from those in non-pregnant women. Our previously defined reference range for TSH of 0.3 to 3.5 mIU/l is equally valid for normal pregnancies. General significance The question of cognition and IQ development of children has been proposed to be associated with thyroid function. The addition of data regarding normal thyroid function during pregnancy will contribute to this research. TSH levels in normal pregnancies do not differ from levels seen in adults. The 10th-percentile value for fT3 in pregnancy is 3.9 pmol/l. The 10th-percentile value for fT4 in pregnancy is 11.3 pmol/l. A drop of TSH levels early in pregnancy is not a general phenomenon.
Collapse
Affiliation(s)
- Roy Moncayo
- Department of Nuclear Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Birgit Zanon
- Kreisklinik Ebersberg, Abtlg. Gynäkologie, Pfarrer-Guggetzerstrasse 3, D-85560 Ebersberg, Germany
| | - Kurt Heim
- LKH Kirchdorf, 4560 Kirchdorf, Austria
| | - Karina Ortner
- Department of Nuclear Medicine, Medical University of Innsbruck, Austria
| | - Helga Moncayo
- WOMED, Karl-Kapferer-Strasse 5, 6020 Innsbruck, Austria
| |
Collapse
|
26
|
Ong GSY, Hadlow NC, Brown SJ, Lim EM, Walsh JP. Does the thyroid-stimulating hormone measured concurrently with first trimester biochemical screening tests predict adverse pregnancy outcomes occurring after 20 weeks gestation? J Clin Endocrinol Metab 2014; 99:E2668-72. [PMID: 25226292 DOI: 10.1210/jc.2014-1918] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONTEXT Maternal hypothyroidism in early pregnancy is associated with adverse outcomes, but not consistently across studies. First trimester screening for chromosomal anomalies is routine in many centers and provides an opportunity to test thyroid function. OBJECTIVE To determine if thyroid function tests performed with first trimester screening predicts adverse pregnancy outcomes. DESIGN, PARTICIPANTS AND SETTING A cohort study of 2411 women in Western Australia with singleton pregnancies attending first trimester screening between 9 and 14 weeks gestation. OUTCOME MEASURES We evaluated the association between TSH, free T4, free T3, thyroid antibodies, free beta human chorionic gonadotrophin (β-hCG) and pregnancy associated plasma protein A (PAPP-A) with a composite of adverse pregnancy events as the primary outcome. Secondary outcomes included placenta previa, placental abruption, pre-eclampsia, pregnancy loss after 20 weeks gestation, threatened preterm labor, preterm birth, small size for gestational age, neonatal death, and birth defects. RESULTS TSH exceeded the 97.5th percentile for the first trimester (2.15 mU/L) in 133 (5.5%) women, including 22 (1%) with TSH above the nonpregnant reference range (4 mU/L) and 5 (0.2%) above 10 mU/L. Adverse outcomes occurred in 327 women (15%). TSH and free T4 did not differ significantly between women with or without adverse pregnancy events. On the multivariate analysis, neither maternal TSH >2.15 mU/L nor TSH as a continuous variable predicted primary or secondary outcomes. CONCLUSION Testing maternal TSH as part of first trimester screening does not predict adverse pregnancy outcomes. This may be because in the community setting, mainly mild abnormalities in thyroid function are detected.
Collapse
Affiliation(s)
- Gregory S Y Ong
- Department of Endocrinology and Diabetes (G.S.Y.O., S.J.B., E.M.L., J.P.W.) and Department of General Medicine (G.S.Y.O.), Sir Charles Gairdner Hospital, Nedlands 6009 Australia; Department of Clinical Biochemistry (N.C.H., E.M.L.), PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands 6009 Australia; and School of Medicine and Pharmacology (J.P.W.), The University of Western Australia, Crawley 6009 Australia
| | | | | | | | | |
Collapse
|
27
|
Yang H, Shao M, Chen L, Chen Q, Yu L, Cai L, Lin Z, Zhang C, Lu X. Screening strategies for thyroid disorders in the first and second trimester of pregnancy in China. PLoS One 2014; 9:e99611. [PMID: 24925135 DOI: 10.1371/journal.pone.0099611] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/16/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Thyroid dysfunction during pregnancy is associated with multiple adverse outcomes, but whether all women should be screened for thyroid disorders during pregnancy remains controversial. OBJECTIVE To evaluate the effectiveness of the targeted high risk case-finding approach for identifying women with thyroid dysfunction during the first and second trimesters of pregnancy. METHODS Levels of thyroid stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibodies (TPOAb) were measured in 3882 Chinese women during the first and second trimester of pregnancy. All tested women were divided into the high risk or non-high risk groups, based on their history, findings from physical examination, or other clinical features suggestive of a thyroid disorder. Diagnosis of thyroid disorders was made according to the standard trimester-specific reference intervals. The prevalence of thyroid disorders in each group was determined, and the feasibility of a screening approach focusing exclusively on high risk women was evaluated to estimate the ability of finding women with thyroid dysfunction. RESULTS The prevalence of overt hypothyroidism or hyperthyroidism in the high risk group was higher than in the non-high risk group during the first trimester (0.8% vs 0, χ2 = 7.10, p = 0.008; 1.6% vs 0.2%, χ2 = 7.02, p = 0.008, respectively). The prevalence of hypothyroxinemia or TPOAb positivity was significantly higher in the high risk group than in the non-high risk group during the second trimester (1.3% vs 0.5%, χ2 = 4.49, p = 0.034; 11.6% vs 8.4%, χ2 = 6.396, p = 0.011, respectively). The total prevalence of hypothyroidism or hyperthyroidism and the prevalence of subclinical hypothyroidism or hyperthyroidism were not statistically different between the high risk and non-high risk groups, for either the first or second trimester. CONCLUSION The high risk screening strategy failed to detect the majority of pregnant women with thyroid disorders. Therefore, we recommend universal screening of sTSH, FT4, and TPOAb during the first trimester and second trimester of pregnancy.
Collapse
|