Association of thyroid antibodies status on the outcomes of pregnant women with hypothyroidism (maternal hypothyroidism on pregnancy outcomes, MHPO-4)

Abstract

Background Autoimmunity increases with age and is often commonly evaluated in women of the reproductive age group. Prevalence of thyroid antibodies is common even in euthyroid pregnant women. We aim to compare the association of thyroid antibody status on the maternal and neonatal outcomes in pregnant women with hypothyroidism. Methods We conducted a cross-sectional retrospective study on 718 cases in the Aga Khan University Hospital. Information was collected on pregnant women who have been diagnosed with hypothyroidism before conception or during their antenatal period. Laboratory data were recorded for thyroid peroxidase antibodies, anti-thyroglobulin antibodies, and thyroid-stimulating hormone levels. Maternal and neonatal outcomes were also noted from medical file records. Data analysis was performed on Statistical Package for the Social Sciences version 20.0. Results Overall, 146 out 718 cases were included for final analysis. Thyroid peroxidase antibodies were positive in 66.4% and anti-thyroglobulin was positive in 52.1% cases, whereas 43.8% of cases had both antibodies positive. Pre-gestational diabetes was significantly associated with thyroid autoimmunity. There was a 73% less chance of gestational hypertension for thyroid autoimmune groups. Gestational diabetes and maternal (chronic) hypertension were found to have an independent effect on postpartum hemorrhage. Hypertensive disorders in pregnancy were found to have an independent risk for premature birth. Conclusion Our study reports a 74.7% prevalence of positive thyroid antibodies in hypothyroid pregnant women, with higher association with pre-gestational diabetes. Gestational hypertension was least likely to occur in thyroid autoimmune groups. None of the outcomes were independently associated with worse outcomes.

The Prevalence of Thyroid Autoimmunity in Pregnancy and Adverse Neonatal Outcomes at a Secondary Care Hospital in the Middle East

“…In another study, IUFD was noted in 2.4% of women with thyroid peroxidase antibodies and 3.1% of women with thyroglobulin antibodies. In women without thyroid antibodies, none of them had any fetal loss [ 35 ]. In a study by Meena et al, no difference was noted in IUFD in both groups.…”

“…In some studies, no association was noted [ 33 ] and some authors have reported prolonged NICU stay in neonates of hypothyroid women with thyroid antibodies [ 29 , 34 ]. Kiran et al have noted lower NICU admissions in women with thyroid antibodies [ 35 ]. Meena et al in 2016 have noted poor neonatal outcomes even in euthyroid women [ 33 ].…”

“…In a study by Meena et al, no difference was noted in IUFD in both groups. Most of these studies had a small sample size of women with IUFD [ 23 , 33 , 35 , 37 ]. Studies with a larger sample size are recommended in this regard.…”

Levothyroxine dosages during pregnancy among hypothyroid women. An experience from a tertiary care center of Karachi, Pakistan, based on data from Maternal Hypothyroidism on Pregnancy Outcomes Study (MHPO-5)

“…All hypothyroid pregnant females presenting to AKUH from 2008 till 2016 were included in this retrospective study. The in-depth methods and other details of the whole population characteristics can be reviewed in our previously published papers [ 9 , 20 ]. We reached a sample size of 280 hypothyroid pregnant women for this study objectives by applying the following eligibility criteria: Pregnant women of 18 years of age above, who had been diagnosed hypothyroidism, either overt (TSH > 10 mIU/mL and FT4 below normal range [10.30–23.17 pmol/L]) or subclinical (TSH > 10 mIU/mL and FT4 normal), by the clinician before pregnancy, as per chart review.…”

Systematic review and meta-analysis on the influence of thyroid dysfunction in early pregnancy on pregnancy outcomes under ultrasound guidance

“…After further intensive reading of the articles, 6 articles without access to original data and uncontrolled studies were excluded. Finally, 13 studies were included for meta-analysis (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). The literature retrieval and screening process is illustrated in Figure 1.…”