Impact of borderline–subclinical hypothyroidism on subsequent pregnancy outcome in women with unexplained recurrent pregnancy loss

Uchida, Hiroshi; Maruyama, Tetsuo; Kagami, Maki; Miki, Fumie; Hihara, Hanako; Katakura, Satomi; Yoshimasa, Yushi; Masuda, H.; Tanaka, Mamoru

doi:10.1111/jog.13319

Cited by 15 publications

(6 citation statements)

References 26 publications

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“…One study reported no significant association between subclinical hypothyroidism and pregnancy loss in women with unexplained recurrent pregnancy loss. In this retrospective study of 317 Japanese women with unexplained recurrent pregnancy loss, Uchida et al found that among women with untreated "borderline" subclinical hypothyroidism, defined as a TSH between 2.5 and 4.5 mIU/L, 29% (9/31) had a subsequent pregnancy loss compared to 17.9% (24/134) of euthyroid controls, P = 0.16 (18).…”

Section: Hypothyroidismmentioning

confidence: 97%

“…b) Adverse Outcomes of Subclinical Hypothyroidism (Question 34) "What adverse outcomes are associated with subclinical hypothyroidism during pregnancy?" Ten studies on adverse outcomes in subclinical hypothyroidism have been published in 2017 and 2018 as noted in Table 1 (9)(10)(11)(12)(15)(16)(17)(18)(19)(20)(21). Two studies reported that subclinical hypothyroidism was associated with changes in fetal growth, however, the changes were different between studies (15,16).…”

Section: Hypothyroidismmentioning

confidence: 99%

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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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Section: Hypothyroidismmentioning

confidence: 97%

Section: Hypothyroidismmentioning

confidence: 99%

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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“…Two studies using a pre‐pregnancy TSH threshold of 2.5 mIU/L found no association with increased miscarriage . To date, three studies have investigated thyroxine replacement in RM patients with SCH diagnosed using TSH >2.5 mIU/L and found no improvement in either miscarriage or live birth.s Also, in a recent large retrospective cohort study involving 5405 pregnant women with SCH, thyroxine replacement was associated with reduced miscarriage only in those with TSH >4 mIU/L and not if TSH was 2.5–4 mIU/L . There are no RCTs examining the impact of thyroxine in RM women with SCH.…”

Section: Endocrine Factors: Thyroid Function Pcos and Prolactinmentioning

confidence: 97%

Modern management of recurrent miscarriage

Homer

2018

Aust NZ J Obst Gynaeco

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Recurrent miscarriage (RM), also known as recurrent pregnancy loss, is a distressing condition affecting around 1% of couples trying to conceive It can be very frustrating for both clinicians and patients as, despite intensive workup, no clear underlying pathology is forthcoming in at least 50% of couples. This leads to despair for patients and leaves clinicians at a loss for how to help. Desperation in both camps can promote the uptake of investigations and interventions of unproven benefit. The pathophysiology underpinning RM is incredibly diverse, involving areas such as haematology, endocrinology, immunology and genetics. During the seven to eight years since the UK Royal College of Obstetricians andGynaecologists published guidelines on this topic in 2011, new evidence and guidance from expert authorities have emerged. Here, these important advances in this challenging field of clinical practice will be reviewed. K E Y W O R D Santiphopholipid syndrome, chromosomal translocation, progesterone, recurrent miscarriage, uterine septum

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“…However, in several studies no adverse perinatal outcomes of SH were found [23][24][25][26]. These inconsistent results may be related to a different criteria of SH diagnosing, co-existance of anti-thyroid antibodies which are attributable to be an independent risk factor for pregnancy adverse outcomes, different maternal age of the studied groups and various gestational age of thyroid function evaluation.…”

Section: Introductionmentioning

confidence: 97%

Subclinical hypothyroidism in pregnancy: controversies on diagnosis and treatment

Gietka-Czernel¹,

Glinicki²

2020

Polish Archives of Internal Medicine

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This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited, distributed under the same license, and used for noncommercial purposes only.

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Impact of borderline–subclinical hypothyroidism on subsequent pregnancy outcome in women with unexplained recurrent pregnancy loss

Abstract: Although some subset of uRPL is though to be due to as-yet-unidentified cause(s), borderline-SCH is unlikely to be involved in uRPL.

Cited by 15 publications

References 26 publications

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

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

Modern management of recurrent miscarriage

Subclinical hypothyroidism in pregnancy: controversies on diagnosis and treatment

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