Subclinical Hypothyroidism and Its Effect on Pregnancy Outcome (original) (raw)
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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.
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...
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 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.
A study of effects of hypothyroidism on antenatal patients
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: After diabetes mellitus, thyroid disorders are the most common endocrine disorders in pregnancy. The most common thyroid gland dysfunction in pregnancy is hypothyroidism with estimated prevalence of 1.5-4.4% of pregnant women. Effects of hypothyroidism in pregnancy include anemia, pre-eclampsia, prematurity, IUGR, low birth weight, mental retardation in neonate. The objective of this study is to find the association of hypothyroidism and its adverse outcomes on mother and the fetus that is listed above.Methods: A study was conducted over a period of 6 months over 50 antenatal patients with hypothyroidism from Jan 2021 to August 2021 in the department of obstetrics and gynecology, Cama and Albless hospital, Mumbai with inclusion, exclusion criteria. History of infertility, family history of thyroid disease, menstrual pattern, recurrent abortion and fetal outcomes were the main study variables.Results: In this study, majority of hypothyroidism belonged to the age group of ...
Pregnancy Outcome in Women with Hypothyroidism
https://www.ijhsr.org/IJHSR\_Vol.7\_Issue.3\_March2017/IJHSR\_Abstract.06.html, 2017
Objective: The present study was to know the pregnancy outcome in women with hypothyroidism. Methods: This randomized prospective study was carried out in the department A total of 2000 pregnant women underwent thyroid function tests (free T 3, free T 4, and TSH) at their first antenatal visit. Quantitative thyroid hormones were measured by ELISA in serum. Results: The data was tabulated and statistically analyzed by applying Student t-test and chi-square test to know the incidence of hypothyroidism in pregnant women and correlate the associations between thyroid disorders and various maternal and perinatal outcomes. A total of 2000 consecutive pregnant women attending the antenatal OPD were included in the study. Out of these 254 women were diagnosed to have hypothyroidism (12.7%). Incidence of preterm labor, placental abruption, IUGR was significantly increased in study group. Conclusion: Systematic screening for hypothyroidism early in pregnancy may be worthwhile and should be commenced at first antenatal visit, preferably in the first trimester. Optimum thyroxine supplementation will obviate many of the maternal and fetal morbidities.
MATERNAL AND FETAL OUTCOME AMONG PREGNANT WOMEN PRESENTING WITH HYPOTHYROIDISM.
International Journal of Advanced Research (IJAR), 2019
Background:Thyroid disorder is the second most common endocrine disorder affecting women of reproductive age. The increased prevalence of thyroid dysfunction in pregnancy and the need for proper management to reduce obstetrical and neonatal adverse events led us to collect the baseline data on hypothyroidism in pregnancy in our population. Material and methods: A total of 1203 consecutive pregnant women attending antenatal clinic in our hospital and consented to participate were studied. All women were tested for TSH levels (determined by chemiluminescent enzyme immunoassay) . Women having higher than normal range of TSH (>2.5mIU/L in first trimester and >3.0mIU/L in second trimester were further tested with repeat TSH & T4. Results: 118 (9.8%) were found to be hypothyroid. The mean age of the women was 26.2?3.7years. 21.2% women had history of previous one or more spontaneous abortions, 15.3% had history of infertility. Symptoms of hypothyroidism were present in 33.9% women, 4.2% women had goiter. Mean BMI was 26.1kg/m2. 72.9% were newly diagnosed in current pregnancy and 27.1% were known cases of hypothyroidism. 18.1% women had pregnancy induced hypertension, 11.9% had preterm labor, and 10.2% each had placental abruption and premature rupture of membranes. 7.6% women had intrauterine growth restriction. Caesarean rate was 41.5% of which 54% were for foetal distress. 16% of neonates were admitted to NICU. Conclusions: Based on the results of this study, we recommend universal screening of hypothyroidism in pregnancy for early diagnosis and treatment of this potentially treatable condition complicating pregnancy.
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.
Subclinical Hypothyroidism in Pregnancy - A Case Series
Bangladesh Journal of Medical Science, 2017
Background: Effects of overt hypothyroidism on pregnancy outcomes and foetal development are well established and treatment protocol is reputable. Method and material: The prevalence and effects of subclinical hypothyroidism (SCH) on pregnancy are not yet clear. Hence, universal screening of all pregnant women is still debatable and treatment of detected sub clinical hypothyroidism is yet to have general consensus as data regarding beneficial effects of treatment to mother and foetus in SCH cases is inadequate. Result: Odisha is a known endemic area of Iodine deficiency and reports of occurrences of SCH in Odisha are very limited. This study is a case series, done to detect the prevalence of SCH in pregnancy in the antenatal unit of a medical college and hospital catering to a large population of Odisha. Conclusion: This prospective study included screening of the pregnant women for thyroid function and follow-up of the cases with SCH till confinement to record any adverse effects of the thyroid dysfunction on obstetric outcome.
Pregnancy outcome in overt hypothyroidism
International Journal of Research in Medical Sciences, 2016
thyroid stimulating hormone (TSH) during pregnancy. 4 This increased TBG concentration leads to an expansion of the extra-thyroidal pool and result in elevated total T 3 and T 4 levels due to an increase in maternal thyroid hormone synthesis. Maternal thyroid synthesis is also increased due to an accelerated renal clearance of iodide resulting from the increased maternal glomerular filtration rate. 5 Women with hypothyroidism have increased risk of abortion, gestational hypertension, anemia, abruptio placentae and postpartum hemorrhage. 6 The risk of these complications is greater in women with overt, rather than subclinical hypothyroidism. 5 Severe maternal hypothyroidism can result in irreversible ABSTRACT Background: To study the pregnancy outcomes in terms of miscarriage, gestational hypertension, preeclampsia, placenta previa, placental abruption, preterm labour, preterm PROM, rate of caesarean section, postpartum hemorrhage, premature birth, low-birth weight, fetal distress in labour, fetal death and congenital anomalies. Methods: The studied subjects included all pregnant women reported to the hospital for a period of one year (November 2012 to October 2013). They were subjected to detailed history, general physical, systemic, local examinations, routine investigations, thyroid function tests (serum TSH, T3, T4) and divided into two groups, Group-I: Overt hypothyroidism (TSH >10Mu/L; T3 and T4 <normal) and Group-II: Euthyroid pregnant women (control group).Outcomes of study group were compared with control group. The data was analyzed using computer software Microsoft Excel and SPSS version 19.0 for Windows. Chi square test was performed to evaluate statistical significance. A p-value of <0.05 was considered as statistically significant. Results: 17045 women reported to hospital during one year period and after applying exclusion criteria 14810 women qualified. Out of these, 14770 pregnant women were found euthyroid and 40 (0.23%) women were overt hypothyroid. Pregnancy outcome like miscarriage (p<0.001), placental abruption (p<0.03), preterm premature rupture of membrane (p=0.003), low birth weight (p<0.001) and premature birth (p=0.003) was found to be statistically significant. Conclusions: Due to adverse pregnancy outcome, women in early pregnancy should be screened for thyroid disorder and those found hypothyroid should be treated.