Subclinical Hypothyroidism in Pregnancy; is There a Need for Pharmacological Intervention? (original) (raw)
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Observational Study of Subclinical Hypothyroidism in Pregnancy
Introduction: Maternal thyroid dysfunction is the second common endocrine disorder during pregnancy. Prevalence of subclinical hypothyroidism during pregnancy is increasing. It is associated with adverse maternal and foetal outcomes like pre-eclampsia, GDM, preterm, IUGR and miscarriage, anaemia, IUD. Objective: To study the prevalence of Subclinical hypothyroidism during pregnancy and its relation with adverse maternal and foetal outcomes. Methods and materials: It was an observational study undertaken at RRMCH from May-2013 to Feb 2014. Pregnant women were screened for thyroid dysfunction irrespective of gestational age. Women with raised Thyroid stimulating Hormone (TSH) were included in the study. Pregnancy outcome of women with raised TSH was compared with euthyroid pregnant women. Results: Study group included 1663 pregnant women. Among them 168 women had hypothyroidism, women with subclinical and overt hypothyroidism were 156 and 12 respectively. Prevalence of hypothyroidism in this study was 10.1%, Subclinical Hypothyroidism and Overt hypothyroidism was 9.3% and 0.72% respectively. Overall prevalence of autoimmunity was 19.04% (n=32) in women with hypothyroidism. Prevalence of autoimmunity in SCH and OH was 17.9% (n=28) and 33.3% (n=4) respectively. In women with SCH 81.4% developed complications like Pre-eclampsia (21.8%), GDM (6.4%), Preterm labor (7.1%) and IUGR (7.7%) anemia (5.8%) compared to euthyroid women (p value <0.001). Conclusions: Increasing prevalence of Subclinical Hypothyroidism during pregnancy and its association with adverse maternal and foetal outcome makes it a high risk factor. Subclinical hypothyroidism is like the bottom of the iceberg, hence prompt screening for thyroid dysfunction and early initiation of treatment can prevent adverse maternal and fetal morbidity.
Subclinical hypothyroidism (SCH) in first trimester of pregnancy
The professional medical journal, 2020
Material & Methods: We obtained informed consent from all patients. 457 pregnant ladies having last missed period till 12 th 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%.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Pregnancy is a stress test of maternal thyroid function. The prevalence of thyroid dysfunction in pregnant women is high. This study is aimed to evaluate maternal and fetal outcomes in pregnant women with deranged thyroid profile. The relevance of this study is to document the association of hypothyroidism and its adverse effects on mother and fetus.Methods: All pregnant mother included in the study are subjected to written consent and detailed history taking and fasting blood sample collection. Blood sample collected in fasting state, because lipidemic content in blood interferes with serum thyroid stimulating hormone (TSH) level if blood sample collected in the fed state.Results: A total of 1000 cases were studied. Out of 1000 cases, 71(7.1%) cases found to be hypothyroid. Among them, 14 (19.4%) had overt hypothyroidism and 57 (80.5%) demonstrated subclinical hypothyroidism.Conclusions: Prevalence of subclinical hypothyroidism is 5.6% in 3rd trimester of pregnancy. Ane...
Effect of Maternal Hypothyroidism on Thyroid hormone status of fetus: A Hospital based study
Journal of Medical Science And clinical Research
Introduction: Thyroid dysfunction is a common endocrinological disorder in pregnancy. It is important for normal development of placenta & early stages of neurodevelopment of foetus. Any deviation from normal activity of thyroid gland is known to be associated with adverse foetomaternal outcome. Aims & Objectives: The study aims to find out thyroid hormonal status in pregnancy and thereafter to determine prevalence of hypothyroidism. Moreover, it aims to find out the effect of maternal hypothyroidism on fetal thyroid hormonal status. Materials & Methods: The study included the estimation of TSH and fT4 level of 142 women during delivery. On the basis of thyroid hormonal status, the patients were divided into 2 groups, with hypothyroidism (n=41) & without hypothyroidism (n=101). Thyroid status of baby (TSH & fT4 level of cord blood) was measured. The data was tabulated & analysed using standard statistical method. Results: Prevalence of hypothyroidism was 28.87%. Statistically significant positive correlation was found between thyroid status of mother & baby [p value >0.001]. Conclusion: maternal hypothyroidism adversely affects the thyroid hormonal status of the fetus; hence early detection of maternal hypothyroidism is very crucial.
Hypothyroidism in Pregnancy: A Hospital based cross sectional study
Innovative publication, 2016
Introduction: Uncontrolled hypothyroidism is associated with serious maternal, fetal, and neonatal morbidity, and mortality. Overt hypothyroidism is defined as a clinical syndrome of hypothyroidism associated with elevated TSH and decreased serum levels of T4 or T3. Subclinical hypothyroidism is defined as a condition without typical symptoms of hypothyroidism, elevated TSH (>5 µU/mL), and normal circulating thyroid hormone.
Management of subclinical hypothyroidism in pregnancy: are we too simplistic?
European Journal of Endocrinology, 2015
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.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Background: To evaluate pregnancy outcome in women with elevated serum thyroid stimulating hormone (TSH) values as compared to those in whom hypothyroidism was treated. Methods: A prospective interventional comparative study was conducted in the department of obstetrics and gynaecology in King Edward Memorial Hospital, Mumbai, India from 2014 to 2015. A cohort of 60 hypothyroid patients was divided into two groups of 30 each. Group 1, euthyroid (treated hypothyroid) and group 2, hypothyroid at the time of labor and pregnancy outcomes were compared. Results: All patients in group 1 delivered at term; whereas in group 2, 9 (30%) patients had preterm deliveries and 21 (70%) delivered at term, amongst which 5 patients delivered babies with severe intrauterine growth restriction (IUGR). Neonatal intensive-care unit (NICU) admission were required for 3 neonates in group 1 and 11 (36.67%) neonates in group 2. Group 1 delivered 5 (16.67%) low birth weight babies (weight <2.5 kg) whereas 16 (53.34%) babies had low birth weight in group 2. Conclusions: Treatment of patients diagnosed with hypothyroidism during pregnancy significantly (p value <0.05) reduced the risk of preterm labor, low birth weight, need for NICU admission.
Subclinical Hypothyroidism in Pregnancy And Outcomes
Background: Screening for subclinical hypothyroidism is essential in all pregnant women, especially in the Indian context, as Indian women have increased risk of developing iodine deficiency during pregnancy. Hence this study was undertaken to study the prevalence of subclinical hypothyroidism. Emphasis was put to know the need for universal screening and also the obstetric outcome in terms of perinatal morbidity and mortality and maternal morbidity were assessed. Methods: It is a retrospective study. Sample size consisted of 200 pregnant women admitted in KIMS,HUBLI during march 2016 to march 2017. Thyroid profile (serum TSH, FT3 and FT4) was done during first visit and in subsequent trimester of each pregnant woman. The results were analyzed taking into consideration recent endocrine society guidelines. Patients with normal thyroid levels were taken as controls. Detailed history taken, physical examination and routine laboratory investigations were done. Patients with SCH were started on Levothyroxine and serial monitoring of TSH done until delivery. The patients were followed up to assess the mode of delivery, maternal and fetal outcome and any associated co-morbidities to serve the secondary objective of the study. Babies of SCH mothers were screened as well to rule out congenital hypothyroidism. Results: Incidence of SCH was found to be 9.5% in the patients studied. Pregnant women with SCH had increased risks of developing anemia (31.5%), preeclampsia (15%), GDM (5%) and prematurity (10%), higher cesarean section rate (36.8%). Neonates of women with SCH had higher incidence poor APGAR score (47.36%), LBW (15%), NICU admission (10%), IUGR (5%). Increased maternal age and more BMI were associated with higher incidence of subclinical hypothyroidism. Conclusions: Prevalence of subclinical hypothyroidism among pregnant women is fairly high among Indians. Screening for subclinical hypothyroidism has to be included as a routine screening test and should be treated accordingly to improve maternal and fetal outcomes.
Effect of Subclinical Hypothyroidism on Maternal and Perinatal Outcome
Zenodo (CERN European Organization for Nuclear Research), 2023
Background:Adverse maternal outcomes and perinatal complications are closely associated with overt maternal hypothyroidism, but whether these complications occur in women with subclinical hypothyroidism (SCH) during pregnancy remains controversial.The aim of this study was to evaluate the effects of SCH on maternal and perinatal outcomes during pregnancy. Methods:This retrospective cohort study was conducted by examining the pregnant women who applied to the Gynaecology Department of Hind Institute of Medical Sciences and Hospital at their 6th to 14th gestational weeks and had antenatal follow-ups between February 1, 2021 and December 31, 2022. Results: The TSH concentration was significantly lower in the first trimester than in the third trimester (P,0.001). The fT4 concentration was higher in the first trimester than in the second and third trimesters (P,0.001). The incidences of GH and PROM were significantly higher in women with SCH than in euthyroid women (5% vs. 1.57%, P= 0.020; 10% vs. 5%, P= 0.002).IUGR was more frequent in women with SCH than in euthyroid women (7.5% vs. 1.3%, P,0.001). More LBW infants were delivered in the SCH group than in the euthyroid group (12.5% vs. 5%, P,0.001). Conclusion:The results of this study indicate that pregnant women with SCH had increased risks of GH and PROM, and their foetuses and infants had increased risks of IUGR and LBW. Thus, routine maternal thyroid function testing is necessary to improve maternal and perinatal outcomes.
IP innovative publication pvt. ltd, 2019
Introduction: Over the past several years it has been proved that maternal thyroid disorders influence the outcome of mother and fetus, during and also after pregnancy. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. Overt hypothyroidism (low serum free T4 & high TSH level) complicates from 2 to 3 pregnancies per 1000 whereas subclinical hypothyroidism (high serum TSH but normal free T4 level) is seen in 2.3% cases.2 Endemic iodine deficiency accounts for most hypothyroidism in pregnant women worldwide whereas chronic autoimmune thyroiditis is the most common cause of hypothyroidism in iodine sufficient parts of the world. Objectives: (1) To detect cases of overt or subclinical hypothyroidism in antenatal mothers in early weeks of gestation by screening methods, (2) To start early treatment in positive cases for reduction of deleterious effects on maternal and fetal outcome, (3) To study the maternal complications during antenatal, intranatal and postnatal period in hypothyroid mothers in comparison to euthyroid pregnancy. (4) To note any difference in incidence of low birth weight babies and early neonatal complications in hypothyroid women. Material and Methods: A prospective clinical study was conducted department of Obstetrics and Gynaecology, Calcutta National Medical College and Hospital, Kolkata, Study population included all pregnant mothers attending antenatal clinic in Calcutta National Medical College and Hospital, Study period was one year (June 2012-May 2013), Sample size is 500 in number. Results: Cases (hypothyroid, TSH>2.3 μU/ml) constituted 4.4% of the screening population, in which the incidence of overt hypothyroid (free T4<0.8 ng/dl) was 0.4% and that of subclinical hypothyroid (fT4 within normal range) was 4.4%. Controls (euthyroid, TSH<2.3 μU/ml) were 95.6% of the study population. Most of the mothers both in cases (71.4%) and controls (89.8%) delivered between 37-40 weeks. Incidences of preeclampsia (36.4% vs. 8.4%), preterm labour (27.3% vs. 6.5%) and intrauterine growth restriction (13.6 vs. 1.3%) were significantly high in hypothyroid mothers than euthyroid group. Spontaneous vaginal deliveries (with or without episiotomy) were more common in controls (77.8%) than cases (45%). Hypothyroid mothers had caesarean section significantly more (50%) than the euthyroid group (20.9%). Among puerperal complications; only post partum haemorrhage was significantly more common in cases than controls (18.2% vs. 5%). Incidence of low birth weight babies (birth weight<2.5kg) were significantly higher in the hypothyroid mothers than the euthyroid group (35% vs. 8.1%). Majority of newborns of cases (65%) had Apgar score 5-7 at 1minute. Significantly increased number of neonates born to hypothyroid mothers had Apgar score<5 at one minute than euthyroid women in this study.