Hypothyroidism in Pregnancy and Its Impact on Maternal and Fetal Outcome

Abstract

Thyroid disorders are most common endocrine disorders affecting women of reproductive age group Hypothyroidism is common in pregnancy with an estimated prevalence of 2-3% Maternal hypothyroidism leads to many maternal and perinatal complications like miscarriage, gestational diabetes mellitus, pre-eclampsia, pre-term labor, placental abruption and fetal death. AIMS AND OBJECTIVE: To find out the effect of hypothyroidism on the course of pregnancy, to study the neonatal outcome, to know the prevalence of subclinical and overt hypothyroidism in pregnant women. MATERIALS AND METHODS: This prospective study was conducted in department of Obstetrics and Gynecology, Pt. J.N.M. Medical College and associated Dr. B.R.A.M. Hospital Raipur from May 2011 to September 2012. All pregnant women attending the obstetric unit during this period were included in the study after informed consent 10 ml of blood sample of pregnant women was drawn at first visit in the first trimester; then it was centrifuged and stored in aliquots at -70 degree Celsius until assays, which were done after delivery, TFT were assessed by quantitative analysis of serum TSH and FT4 (ELISA). The pregnancy outcome variables like miscarriages, preterm deliveries, IUGR, preeclampsia, anemia, low birth weight, intra uterine fetal demise, antepartum hemorrhage, still birth, postpartum haemorrhage, birth asphyxia were studied. The neonatal outcome was also studied. The statistical analysis was done using odds ratio. P value <0.05 was considered significant. RESULTS: Out of the 263 pregnant women 25 had hypothyroidism (9.5%). Prevalence of subclinical hypothyroidism was more as compared to overt one (Table 2). Abortions were seen in 12.5% of subclinical and 11.1% of overt hypothyroid women. PIH and abruptions were significantly higher in subclinical cases (P<0.05) while in overt group both complications were higher as compared to the normal women but p value was not significant for abruption. More of the hypothyroid women had preterm delivery (37.5% in subclinical and 44.4% in overt group), Regarding neonatal complications IUD and Early neonatal deaths were significantly higher in overt hypothyroidism (P<0.01) Hypothyroid women had more of low birth weight babies (31.25% in subclinical and 35.5% in overt) and IUGR babies (18.70% in subclinical and 22.21% in overt), CONCLUSION: The present study shows that, though the occurrence of hypothyroidism in pregnancy is less yet it causes many maternal and neonatal complications therefore universal screening of thyroid disorder should be done in pregnancy.

Relationship Between Subclinical Hypothyroidism in Pregnancy and Hypertensive Disorder of Pregnancy: A Systematic Review and Meta-Analysis

“…A total of 4808 patients with subclinical hypothyroidism, 94306 with euthyroidism, and the rest with other thyroid diseases [there is a part of the repeated population because Li, M.F., et al. and his colleagues assessed the same population with different diagnostic criteria, respectively ( 10 )].There were 15 prospective cohort studies ( 16 – 20 , 22 – 29 , 31 , 32 ) and 7 retrospective cohort studies ( 4 , 7 , 10 , 11 , 21 , 30 , 33 ). In addition, due to slight differences in thyroid parameters during different pregnancy periods, there were 10, 6, and 1 studies evaluating the relationship between subclinical hypothyroidism in pregnancy and HDP in the first, second, and third trimesters, respectively.…”

“…We then further searched the full texts of 40 articles to assess their eligibility, of which 15 were case-control studies, 2 studies were poorly defined for disease, and 2 studies that did not provide HDP-related data were excluded. Eventually, we included 22 original studies to investigate the relationship between subclinical hypothyroidism in pregnancy and HDP (7,10,11,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). (10)].…”

Prediction of Low Birth Weight by Quadruple Parameters in High-Risk Pregnancies

“…Hypothyroidism was also found to be a major cause of miscarriage in some studies, but in our study, we did not observe much variations in adversity among the group comparatively. [ 15 , 16 ] Whereas a prospective study on elderly pregnant (>35 years) women belonging to the western part of India has found a significantly higher proportion of maternal and fetal mortality and morbidity among them. Antenatal and intranatal complications were increased in their study group along with an increased incidence of LBW babies compared to the comparison group (40.20% vs. 24%).…”

Prevalence and outcome of hypothyroidism in women attending antenatal clinic at J. J. M Medical College

“…[12][13][14] Thus presence of thyroid autoantibodies can cause dysregulated activity of immune system at fetal-maternal interface causing abortions and preterm labour. 15 Ruchi Kishore et al studied about fetal outcome in hypothyroid women and concluded that 6.2% were IUD and 13% were IUGR in hypothyroid patients. 16 In present study, fetal outcome was; IUGR 3.3% and 1.3% cases of IUD.…”