Maternal antithyroid antibodies and euploid miscarriage in women with recurrent early pregnancy loss

Cueva, Shirley; Burks, Channing; McQueen, Dana B.; Barkoff, Marla S.; Stephenson, Mary D.

doi:10.1016/j.fertnstert.2018.04.026

Cited by 16 publications

(8 citation statements)

References 24 publications

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“…Iravani 17 excluded some participants who had serum TSH levels outside the reference range. In the other studies (Mecacci 2000, 47 Lata 2013, 41 Curve 49 ), the TSH level was significantly higher than normal (>2.5 mIU/L). The data from Curve 49 included some subclinical hypothyroidism patients.…”

Section: Discussionmentioning

confidence: 68%

“…We examined the difference of mean basal serum TSH between the TPO‐Ab‐positive and TPO‐Ab‐negative group. Six studies compared it with and without TPO‐Ab 2,17,41,47‐49 . From the meta‐analysis, it emerged that TPO‐Ab‐positive women had significantly higher serum TSH levels (random‐effect SMD = 0.60; 95% CI, 0.31 to 0.90; P < .0001; Figure 6A).…”

Section: Resultsmentioning

confidence: 99%

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Effect of antithyroid antibodies on women with recurrent miscarriage: A meta‐analysis

Xie

Jiang

Sadhukhan

et al. 2020

American J Rep Immunol

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Problem The effect of thyroid autoimmunity (TAI) on the prevalence of recurrent miscarriage (RM) is highly debatable. No meta‐analysis has been published in the past decade to investigate the impact of TAI on women with RM. Method of Study Systemic literature search was conducted on PubMed, Embase, Cochrane, and Web of Science databases. English language literatures published between 1993 and 2019 were selected. We assessed the relationship between the prevalence of RM and thyroid peroxidase antibodies (TPO‐Ab) or antithyroid antibodies (ATA) and evaluated the thyroid‐stimulating hormone (TSH) level in TPO‐Ab‐positive women with RM. We also observed the treatment effect with levothyroxine (LT4) for RM. Review Manager 5.3 software was used to obtain the pooled odds ratios (OR). Results Analysis of 22 eligible studies revealed significant association between TPO‐Ab and the prevalence of RM (OR = 1.85; 95% CI, 1.38 to 2.49; P < .001)(n ≥ 3), (OR = 1.82; 95% CI, 1.13 to 2.92; P = .01) (n ≥ 3). Women with ATA + had higher risk of RM (OR = 2.36; 95% CI, 1.71 to 3.25; P < .00001)(n ≥ 3), (OR = 2.34; 95% CI, 1.70 to 3.22; P < .00001)(n ≥ 2). RM women with TPO‐Ab had higher TSH level when compared with those negative for TPO‐Ab (random‐effect SMD = 0.60; 95% CI, 0.31 to 0.90; P < .0001). We also found beneficial effects of LT4 supplementation on the outcome of live birth rate (LBR) among pregnant women with TPO‐Ab (OR = 3.04; 95% CI, 0.69 to 13.36; P = .14). Conclusion The presence of serum antithyroid antibodies does harms to women and can even lead to recurrent miscarriage; LT4 treatment may have beneficial to RM women.

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Section: Discussionmentioning

confidence: 68%

Section: Resultsmentioning

confidence: 99%

Effect of antithyroid antibodies on women with recurrent miscarriage: A meta‐analysis

Xie

Jiang

Sadhukhan

et al. 2020

American J Rep Immunol

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“…The 2017 ATA guidelines conclude that, "the data for an association between thyroid antibodies and recurrent pregnancy loss are less robust than for sporadic loss." The study by Cueva et al (37) supports this statement. However, the presence or absence of an association remains an open question, and additional studies will be required to fully answer this question.…”

Section: B) Autoimmunity and Recurrent Miscarriage (Question 17)mentioning

confidence: 78%

“…One study was published on thyroid autoimmunity in recurrent pregnancy loss. In an observational study of 74 American women with recurrent early pregnancy loss, Cueva et al found no difference in the frequency of euploid miscarriage in women with or without thyroid autoimmunity, 42% (5/12) vs. 56% (28/50), respectively, P > 0.05 (37). The 2017 ATA guidelines conclude that, "the data for an association between thyroid antibodies and recurrent pregnancy loss are less robust than for sporadic loss."…”

Section: B) Autoimmunity and Recurrent Miscarriage (Question 17)mentioning

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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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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“…The role of thyroid autoantibodies in recurrent pregnancy loss has also been studied. A small observational cohort study of pregnant people in the United States with a history of recurrent pregnancy loss found no difference in miscarriage frequency between persons who are positive for thyroid autoantibodies (either euthyroid or with subclinical hypothyroidism) and those without these autoantibodies 33 . In contrast, the 2020 systematic review by Dong et al reported a significant association between thyroid autoimmunity and recurrent pregnancy loss (OR, 1.94; 95% CI, 1.43‐2.64; no P value included) 32 .…”

Section: Pathophysiology Of Hypothyroidism In Pregnancymentioning

confidence: 99%

Antepartum Care for Pregnant People with Overt Hypothyroidism, Subclinical Hypothyroidism, and Positive Thyroid Autoantibodies

Mayhew

Simonson

Bowers

2022

J Midwife Womens Health

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Maternal thyroid hormones are critical for the growth and development of a healthy fetus. During pregnancy, maternal thyroid hormone production is increased to meet the demands of fetal growth. The purpose of this review is to provide clinicians with current evidence about possible adverse maternal and fetal effects of hypothyroidism in pregnancy, including the role of hypothyroidism in recurrent pregnancy loss. In addition, clinical presentation, evidence-based screening guidelines, and evidence-based treatments are discussed.

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Maternal antithyroid antibodies and euploid miscarriage in women with recurrent early pregnancy loss

Abstract: Our study did not demonstrate an association between euploid miscarriage and maternal antithyroid antibodies in subjects with a history of REPL. Therefore, testing or treatment in this cohort may not be warranted.

Cited by 16 publications

References 24 publications

Effect of antithyroid antibodies on women with recurrent miscarriage: A meta‐analysis

Effect of antithyroid antibodies on women with recurrent miscarriage: A meta‐analysis

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

Antepartum Care for Pregnant People with Overt Hypothyroidism, Subclinical Hypothyroidism, and Positive Thyroid Autoantibodies

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