Childhood maltreatment is associated with increased risk of subclinical hypothyroidism in pregnancy

Abstract

The critical importance of thyroid hormones for fetal development is well established. The developing fetus is dependent on the mother for adequate thyroid hormone supply, and maternal thyroid dysfunction in pregnancy may result in suboptimal fetal development. Because exposure to childhood maltreatment (CM) has been associated with thyroid dysfunction in the non-pregnant state, we sought to test the hypothesis that exposure to CM may represent a risk factor for the development of maternal hypothyroidism in pregnancy. The study was conducted in a healthy cohort of 102 pregnant mothers who were followed across the entire course of pregnancy. At each trimester thyroid-stimulating hormone (TSH) and free thyroxine (fT4) were measured in maternal serum. Experience of CM was assessed using the Childhood Trauma Questionnaire. After adjusting for potentially confounding variables, CM exposure was associated with increased TSH concentrations across pregnancy (F1,94.6=11.52, p=.001) and with a 4- to 7-fold increased risk of TSH levels above the trimester-specific clinical cut-off values. Women with clinically elevated TSH concentrations did not differ in fT4 concentrations from women with normal TSH concentrations (p > .1), suggesting subclinical hypothyroidism. Our findings suggest that there is a substantial and clinically relevant increased risk for thyroid dysfunction during pregnancy among women exposed to abuse or neglect in their childhood. This could potentially have adverse consequences for fetal brain development. Thus, these findings highlight the critical importance of considering CM exposure as a potential risk factor for (subclinical) hypothyroidism in pregnancy.

Thyroid Functioning and Fatigue in Women With Functional Somatic Syndromes – Role of Early Life Adversity

“…Very few studies have investigated how HPT functioning in general may be altered as a result of adverse experiences during childhood. Most recently, Moog et al (2017) were able to demonstrate that women with moderate to severe childhood trauma had a significantly enhanced risk of subclinical hypothyroidism during pregnancy, as indicated by higher circulating levels of TSH. Another study found altered fT3 in women reporting a history of sexual abuse when compared to non-abused women ( Bunevicius et al, 2012 ).…”

“…Interestingly, there is evidence to suggest that early life adversity can modulate HPT functioning. For instance, a recent study found higher TSH in pregnant women with versus without childhood trauma ( Moog et al, 2017 ). Similarly, altered circulating levels of fT3 were shown in women with childhood sexual abuse when compared to non-traumatized women, the direction of which depended on whether they had a menstrually related mood disorder or not ( Bunevicius et al, 2012 ).…”

Social Functioning in Individuals Affected by Childhood Maltreatment: Establishing a Research Agenda to Inform Interventions

“…In low- and high-income countries, women exposed to CM are at increased risk of developing postpartum depression [ 9 ], which in turn increases the risk of impaired maternal-child attachment [ 10 ] and depression in the child [ 11 ]. CM is also associated with increased risk of subclinical hypothyroidism in pregnancy [ 12 ]. Furthermore, potential associations between maternal exposure to CM, fetal brain development [ 13 ], brain anatomy [ 14 ], and obesity in the newborn [ 15 ] are well documented.…”

Life-course effects of early life adversity exposure on eating behavior and metabolism

“…Childhood abuse leads to altered serum TSH and thyroid hormones levels. Early life trauma evaluated using CTQ is associated with reduced T3 levels, but not with altered peripheral T4 levels in adolescents (Machado et al, 2015), and increased TSH levels in women that experienced childhood trauma have also been found (Bunevicius, Leserman, & Girdler, 2012;Moog et al, 2017), suggesting enhanced risk of hypothyroidism. On the other hand, some distinct effects of childhood trauma have also been reported on HPT function in women with functional somatic syndrome (Fischer et al, 2018), and with post-traumatic stress disorder (Friedman, Wang, Jalowiec, McHugo, & McDonagh-Coyle, 2005), in which higher childhood trauma was associated with lower TSH.…”