Evaluation of Adverse Effects of Hypothyroidism During Antenatal Period With Maternal and Fetal Outcomes in Subjects With Subclinical and Overt Hypothyroidism

Abstract

Objectives: Maternal thyroid hormone excess or deficiency can influence the outcome of the mother and fetus at all stages of pregnancy as well as interfere with ovulation and infertility. In females who suffer from thyroid diseases before pregnancy or during pregnancy, these hormonal changes are magnified leading to adverse maternal and fetal outcomes. This study is done to evaluate the adverse effects of hypothyroidism during the antenatal period, maternal and fetal outcomes in patients with subclinical and overt hypothyroidism (OH). Methods: The present prospective case–control study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital Patiala, Punjab, from August 2018 to July 2019. The study was conducted among 150 antenatal patients, who had singleton pregnancy irrespective of age and parity. A complete thyroid profile was done to segregate them into euthyroid, subclinical hypothyroidism, and OH. Patients were divided into two groups, In group I, there were 75 antenatal patients who were euthyroid, and in group II, there were 75 antenatal patients with subclinical or OH diagnosed in pregnancy or already on treatment. The adverse maternal and fetal complications were noted in two groups. Data were compared using t-test for parametric data and Chi-square test for non-parametric data. Data presented as mean and standard deviation with p≤0.05 was considered statistically significant. Results: In the current study, 4 (5.33%) patients in group II, 0 patient in group I had abortions giving p=0.011. 7 (9.3%) patients of group II, 0 patient in group I had intra uterine death giving a p=0.001. In group I, 1 (1.33%) patient, 8 (10.6%) patients in group II developed pregnancy-induced hypertension giving p=0.025. In group I, 6 (8%) patients, 25 (33.3%) in group II had preterm delivery giving p=0.018. In group I, 7 (9.33%) patients underwent induction of labor, and in group II, 19 (25.3%) patients were induced giving p=0.009. In group I, 2 (2.67%) patients, 10 (13.3%) patients in group II had undergone C-section giving p=0.006. In group I, 2 (2.67%) patients had fetal growth restriction babies as compared to 10 (13.3%) in group II giving p=0.006. In group I, 1 (1.33%) baby had an APGAR score <9 at 5 min and 15 (20%) in group II patients giving p=0.001. Neonatal intensive care unit admissions were 7 (9.33%) in group I as compared to 19 (25.33%) in group II giving p=0.018. Conclusion: In the present study, it was observed that the prevalence of thyroid disorder in pregnant women is considerably high with subclinical hypothyroidism being most common followed by OH. A simple screening test of thyroid profile, if used to timely diagnose hypothyroidism a large number of maternal and fetal complications can be prevented.