First trimester isolated maternal hypothyroxinaemia: adverse maternal metabolic profile and impact on the obstetrical outcome

Furnica, Raluca Maria; Gruson, Damien; Lazarus, John; Maiter, Dominique; Bernard, Pierre; Daumerie, Chantal

doi:10.1111/cen.13301

Cited by 20 publications

(20 citation statements)

References 35 publications

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“…Thyroid dysfunction during pregnancy is a matter of concern today, due to its widespread presence in pregnant women and the potential risk to children’s neurodevelopment. However, its relationship with clinical obstetric trimester variation is still controversial (17, 18, 19). The aetiology of IMH is still not well known, but iodine deficiency is proposed as a main one (20).…”

Section: Discussionmentioning

confidence: 99%

Association between isolated hypothyroxinaemia in early pregnancy and perinatal outcomes

Zhao

Cao

et al. 2019

Endocrine Connections

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Background The effect of isolated maternal hypothyroxinaemia (IMH) on pregnancy complications and neonatal outcomes in human beings is still controversial. Methods This was a retrospective cohort study based on the electronic medical register system. The records of women with a singleton pregnancy who sought antenatal examination between January 2014 and December 2015 at Shanghai First Maternity and Infant Hospital were extracted from the electronic medical records system. Thyroid-stimulating hormone (TSH), free thyroxine (fT4) and anti-thyroperoxidase autoantibody (TPO-Ab) was measured before 20 gestational weeks, and a multiple logistic regression model was used to estimate the odds ratios of pregnancy complications and neonatal outcomes between euthyroid women and those with isolated hypothyroxinaemia. Results A total of 8173 women were included in this study, of whom 342 (4.18%) were diagnosed with IMH. Regression analysis showed that IMH diagnosed in the second trimester (13–20 weeks) was associated with an increased risk of hypertensive disorders of pregnancy (OR = 2.66, 95% CI: 1.38–5.10) and placenta abruption (OR = 3.64, 95% CI: 1.07–12.41), but not with preterm delivery (OR = 1.09, 95% CI: 0.50–2.40), small or large gestational age of infant (OR = 0.91, 95% CI: 0.39–2.12; OR = 1.16, 95% CI: 0.72–1.86), macrosomia (OR = 1.71, 95% CI: 0.95–3.07), gestational diabetes mellitus (OR = 1.36, 95% CI: 0.86–2.15) and placenta previa (OR = 1.62, 95% CI: 0.39–7.37). Conclusion IMH could be a risk factor for hypertensive disorders of pregnancy.

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Section: Discussionmentioning

confidence: 99%

Association between isolated hypothyroxinaemia in early pregnancy and perinatal outcomes

Zhao

Cao

et al. 2019

Endocrine Connections

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“…Despite this negative result, which may have been due to differences in women’s average age and ethnicity, most studies have clearly indicated adverse pregnancy outcomes for IMH. European research that included 879 pregnant women found that IMH during the early pregnancy was associated with an increased risk of macrosomia compared with a control group [ 17 ]. Women with hypothyroxinemia had significantly increased BMI from preconception to the time of delivery.…”

Section: Discussionmentioning

confidence: 99%

The impact of isolated maternal hypothyroxinemia during the first and second trimester of gestation on pregnancy outcomes: an intervention and prospective cohort study in China

Gong

Liu

et al. 2018

J Endocrinol Invest

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Objectives To explore the effect of isolated maternal hypothyroxinemia (IMH) during the first and second trimester of gestation on pregnancy outcomes. To explore whether levothyroxine (L-T4) treatment of women who had IMH identified in the first trimester improves pregnancy outcomes. Methods Women in the early pregnancy in the iodine-sufficient area ( n = 3398) were recruited to this prospective cohort study (ChiCTR-TRC-12002326). Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibody (TPOAb) were detected. Women with IMH before 12 weeks chose to receive L-T4 or remain untreated. The L-T4 dose was adjusted to attain a normal FT4 and TSH level. Pregnancy outcomes were evaluated during follow-up. Results IMH in the first trimester was not associated with increased risk of adverse pregnancy outcome compared with controls. The incidence of macrosomia ( p = 0.022) and gestational hypertension ( p = 0.018) was significantly higher in IMH identified in the second trimester of gestation compared with controls. IMH identified in the second trimester of gestation was a risk factor for macrosomia [adjusted odds ratio (aOR) 1.942, 95% CI 1.076–3.503, p = 0.027] and gestational hypertension (aOR 4.203, 95% CI 1.611–10.968, p < 0.01), when body mass index in the early pregnancy was < 25 kg/m 2 . Conclusions IMH in the first trimester did not increase the risk of adverse outcomes irrespective of whether women received L-T4 treatment. However, IMH identified in the second trimester was associated with increased risk of adverse pregnancy outcome. The results suggest that thyroid function follow-up during the second trimester is necessary, even if thyroid function is normal during the first trimester. Electronic supplementary material The online version of this article (10.1007/s40618-018-0960-7) contains supplementary material, which is available to authorized users.

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“…Both studies are thus vulnerable to a high risk of false positive findings; therefore, further studies are needed. Other studies showed association between maternal isolated hypothyroxinemia with breech presentation or Cesarean section (28), preeclampsia (29) and macrosomia (11,28), the results from these isolated observational studies require additional confirmation. Thus, current evidence continues to support the statements made in the 2017 ATA Guidelines regarding isolated hypothyroxinemia in pregnancy.…”

Section: C) Treatment Of Subclinical Hypothyroidism (Question 37)mentioning

confidence: 85%

The Need for Dynamic Clinical Guidelines: A Systematic Review of New Research Published After Release of the 2017 ATA Guidelines on Thyroid Disease During Pregnancy and the Postpartum

2020

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Background: The American Thyroid Association Guidelines on Thyroid Disease During Pregnancy and the Postpartum (ATA Guidelines) were published in 2017, with an update not expected for another 5 years. Since release of the 2017 ATA Guidelines, greater than 500 articles have been published in the field. Furthermore, there are presently 14 prospective, interventional trials in progress registered at Clinicaltrials.gov Static guidelines updated every 5-7 years fail to provide timely evidence-based guidance to practicing clinicians. Consequently, guideline development should move toward the creation of dynamic documents. The present article reviews the literature published since the 2017 ATA Guidelines, both to benefit clinicians in practice and to make the case for Dynamic ATA Guidelines. Methods: Using the search terms "thyroid" and "pregnancy," a systematic review of literature published in Pubmed from 3/1/2017 to 12/31/2018 was conducted. The titles and/or abstracts of all articles were reviewed. All articles were classified by subject headings used in the 2017 ATA Guidelines. English-text articles classified under "hypothyroidism" or "thyroid autoimmunity" were examined in full-text. Using the questions and recommendations put forth by the previous ATA Guidelines, relevant articles were selected for discussion in this review. Results: At the time of the search, 659 unique articles on "thyroid and pregnancy" were identified, including 66 original studies on hypothyroidism and 26 on thyroid autoimmunity. Of these, 26 studies on hypothyroidism and 18 studies on thyroid autoimmunity were selected for inclusion in this review based on specific questions in the 2017 ATA Guidelines. Based on these 44 articles, we propose two specific changes to the 2017 ATA Guidelines. Conclusion: Based on new research, we recommend the 2017 ATA Guidelines be updated to recommend against treating thyroid antibody-negative women diagnosed Dong et al. Thyroid in Pregnancy Since 2017 with subclinical hypothyroidism in the second trimester or later; to reflect new, moderate-quality evidence supporting the treatment of thyroid peroxidase antibody-negative women with elevated thyroid stimulating hormone levels in the first trimester or earlier; and to recommend against treatment of euthyroid, thyroid peroxidase antibody-positive women undergoing assisted reproductive technology. Transitioning to a Dynamic ATA Guidelines would allow for these and future recommendations to be implemented in real time.

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First trimester isolated maternal hypothyroxinaemia: adverse maternal metabolic profile and impact on the obstetrical outcome

Cited by 20 publications

References 35 publications

Association between isolated hypothyroxinaemia in early pregnancy and perinatal outcomes

Association between isolated hypothyroxinaemia in early pregnancy and perinatal outcomes

The impact of isolated maternal hypothyroxinemia during the first and second trimester of gestation on pregnancy outcomes: an intervention and prospective cohort study in China

The Need for Dynamic Clinical Guidelines: A Systematic Review of New Research Published After Release of the 2017 ATA Guidelines on Thyroid Disease During Pregnancy and the Postpartum

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