Effect of maternal hyperthyroidism during late pregnancy on the risk of neonatal low birth weight

Phoojaroenchanachai, Meta; Sriussadaporn, Sutin; Peerapatdit, Thavatchai; Vannasaeng, Sathit; Nitiyanant, Wannee; Boonnamsiri, Vipa; Vichayanrat, A

doi:10.1046/j.1365-2265.2001.01224.x

Cited by 115 publications

(75 citation statements)

References 20 publications

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“…Previous studies evaluating the impact of maternal hyperthyroidism have consistently showed an increased risk of neonatal LBW [5] [15] [23] [24], which were confirmed in this study. However, OR in our study was much lower than in previous studies.…”

Section: Discussionsupporting

confidence: 80%

Maternal Thyroid Disease and Neonatal Low Birth Weight: A Systematic Review and Meta-Analysis

Chiu¹,

Zhang²,

Zhao³

et al. 2017

OJOG

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Objective: Thyroid disorder is a common endocrine complication in pregnant women: the association between neonatal low birth weight (LBW) and thyroid dysfunction during pregnancy has not been definitely confirmed. We conduct a systematic literature review and meta-analysis of the adverse fetal complication of LBW in maternal thyroid disease, including overt and subclinical hyperthyroidism and hypothyroidism. Methods: Relevant studies in English published between 1990 and 2016 were identified by searching PubMed, Medicine, and Embase databases. Cohort studies that evaluated the association between LBW infants and overt and subclinical hyperthyroidism or hypothyroidism during pregnancy and included a healthy pregnancy reference group were selected. The combined odds ratio (OR) with 95% confidence intervals (CI) were calculated to evaluate this relationship. Results: A total of 11 cohort studies (1,171,052 participants) assessed the association between maternal thyroid disease and LBW infants. An increased risk for LBW in hyperthyroidism pregnancies was demonstrated (OR: 1.30, 95% CI 1.11 -1.54; p = 0.02). No significant increased risk for LBW was detected in subclinical hyperthyroidism (OR 1.03; 95% CI 0.72 -1.48; p = 0.87), or hypothyroidism pregnancies (overt: OR 0.98; 95% CI 0.88 -1.10; p = 0.75; subclinical: OR 1.29; 95% CI 0.81 -2.04; p = 0.28). Conclusion: Data show a higher trend towards an increased risk of LBW among infants from maternal hyperthyroidism pregnancies. No association was seen in subclinical cases of hyperthyroidism or hypothyroidism during pregnancy.

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Section: Discussionsupporting

confidence: 80%

Maternal Thyroid Disease and Neonatal Low Birth Weight: A Systematic Review and Meta-Analysis

Chiu¹,

Zhang²,

Zhao³

et al. 2017

OJOG

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“…Several studies have shown that obstetrical and medical complications are directly related to control of hyperthyroidism and the duration of the euthyroid state in pregnancy (80)(81)(82)(83). Poor control of thyrotoxicosis is associated with miscarriages, pregnancy-induced hypertension, prematurity, low birth weight, intrauterine growth restriction, stillbirth, thyroid storm, and maternal congestive heart failure (84).…”

Section: And Recommendation 27mentioning

confidence: 99%

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Alexander

Pearce

Brent

et al. 2017

Thyroid

2,059

2,716

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INTRODUCTION Pregnancy has a profound impact on the thyroid gland and thyroid function. The gland increases 10% in size during pregnancy in iodine-replete countries and by 20%-40% in areas of iodine deficiency. Production of thyroxine (T 4 ) and triiodothyronine (T 3 ) increases by 50%, along with a 50% increase in the daily iodine requirement. These physiological changes may result in hypothyroidism in the later stages of pregnancy in iodine-deficient women who were euthyroid in the first trimester. The range of thyrotropin (TSH), under the impact of placental human chorionic gonadotropin (hCG), is decreased throughout pregnancy with the lower normal TSH level in the first trimester being poorly defined and an upper limit of 2.5 mIU/L. Ten percent to 20% of all pregnant women in the first trimester of pregnancy are thyroid peroxidase (TPO) or thyroglobulin (Tg) antibody positive and euthyroid. Sixteen percent of the women who are euthyroid and positive for TPO or Tg antibody in the first trimester will develop a TSH that exceeds 4.0 mIU/L by the third trimester, and 33%-50% of women who are positive for TPO or Tg antibody in the first trimester will develop postpartum thyroiditis. In essence, pregnancy is a stress test for the thyroid, resulting in hypothyroidism in women with limited thyroidal reserve or iodine deficiency, and postpartum thyroiditis in women with underlying Hashimoto's disease who were euthyroid prior to conception.Knowledge regarding the interaction between the thyroid and pregnancy/the postpartum period is advancing at a rapid pace. Only recently has a TSH of 2.5 mIU/L been accepted as the upper limit of normal for TSH in the first trimester. This has important implications in regards to interpretation of the literature as well as a critical impact for the clinical diagnosis of hypothyroidism. Although it is well accepted that overt hypothyroidism and overt hyperthyroidism have a deleterious impact on pregnancy, studies are now focusing on the potential impact of subclinical hypothyroidism and subclinical hyperthyroidism on maternal and fetal health, the association between miscarriage and preterm delivery in euthyroid women positive for TPO and/or Tg antibody, and the prevalence and long-term impact of postpartum thyroiditis. Recently completed prospective randomized studies have begun to produce critically needed data on the impact of treating thyroid disease on the mother, fetus, and the future intellect of the unborn child.It is in this context that the American Thyroid Association (ATA) charged a task force with developing clinical guidelines on the diagnosis and treatment of thyroid disease during pregnancy and the postpartum. The task force consisted of international experts in the field of thyroid disease and pregnancy, and included representatives from the ATA, Asia and Oceania Thyroid Association, Latin American Thyroid Society, American College of Obstetricians and Gynecologists, and the Midwives Alliance of North America. Inclusion of thyroidologists, obstetricians, and midwives ...

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“…Overt hyperthyroidism has well-documented adverse impacts on pregnancy outcomes (8)(9)(10). Therefore, despite its rarity, recognition and proper management of hyperthyroidism during pregnancy is of utmost importance.…”

Section: Introductionmentioning

confidence: 99%

Management of hyperthyroidism during pregnancy and lactation

Azizi

Amouzegar²

2011

European Journal of Endocrinology

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Introduction: Poorly treated or untreated maternal overt hyperthyroidism may affect pregnancy outcome. Fetal and neonatal hypo-or hyper-thyroidism and neonatal central hypothyroidism may complicate health issues during intrauterine and neonatal periods. Aim: To review articles related to appropriate management of hyperthyroidism during pregnancy and lactation. Methods: A literature review was performed using MEDLINE with the terms 'hyperthyroidism and pregnancy', 'antithyroid drugs and pregnancy', 'radioiodine and pregnancy', 'hyperthyroidism and lactation', and 'antithyroid drugs and lactation', both separately and in conjunction with the terms 'fetus' and 'maternal.' Results: Antithyroid drugs are the main therapy for maternal hyperthyroidism. Both methimazole (MMI) and propylthiouracil (PTU) may be used during pregnancy; however, PTU is preferred in the first trimester and should be replaced by MMI after this trimester. Choanal and esophageal atresia of fetus in MMI-treated and maternal hepatotoxicity in PTU-treated pregnancies are of utmost concern. Maintaining free thyroxine concentration in the upper one-third of each trimester-specific reference interval denotes success of therapy. MMI is the mainstay of the treatment of post partum hyperthyroidism, in particular during lactation. Conclusion: Management of hyperthyroidism during pregnancy and lactation requires special considerations and should be carefully implemented to avoid any adverse effects on the mother, fetus, and neonate.

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Effect of maternal hyperthyroidism during late pregnancy on the risk of neonatal low birth weight

Cited by 115 publications

References 20 publications

Maternal Thyroid Disease and Neonatal Low Birth Weight: A Systematic Review and Meta-Analysis

Maternal Thyroid Disease and Neonatal Low Birth Weight: A Systematic Review and Meta-Analysis

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Management of hyperthyroidism during pregnancy and lactation

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