Maternal characteristics and outcomes affected by hypothyroidism during pregnancy (maternal hypothyroidism on pregnancy outcomes, MHPO-1)

Abstract

Background: Hypothyroidism in pregnancy is an arena of ongoing research, with international conflicts regarding screening, management, and outcomes. Various studies have described the outcomes depending on geographical and international diagnostic criteria. No study has been conducted in this regard from the region of Pakistan. Therefore, we aim to report the clinical features and maternal outcomes of hypothyroid pregnancies and compare the maternal outcomes between uncontrolled and controlled TSH levels in the preconception as well as the gestational period. Methods: We conducted a cross-sectional retrospective study on 718 cases in the Aga Khan University Hospital after ethical approval. We collected information on pregnant females who have diagnosed hypothyroidism before conception or during their antenatal period. We noted the maternal characteristics and maternal comorbidities. Laboratory data were recorded for thyroid stimulating hormone levels before conception and during gestation. We recorded maternal outcomes as pregnancy loss (including miscarriage, stillbirth/intrauterine death, medical termination of pregnancy and ectopic pregnancy), gestational hypertension, pre-eclampsia, postpartum hemorrhage, placental abruption, and modalities of delivery. Data analysis was performed on Statistical Package for the Social Sciences version 20.0. Results: Among 708 hypothyroid women 638 had live births. Postpartum hemorrhage was the most frequent maternal outcome (38.8%). The emergency cesarean section occurred in 23.4% of cases. We determined TSH levels in 53.2, 56.7, 61.7 and 66.6% of cases in preconception, 1st, 2nd, and 3rd trimester periods. A significant association existed between cesarean section and preconception thyrotropin levels > 2.5 mIU/L, whereas postpartum hemorrhage was significantly associated with thyrotropin levels > 2.5 mIU/L in the preconception and third trimester. Conclusion: Successful live births in our patients were complicated by maternal postpartum hemorrhage and a frequent number of emergency cesarean section.

Prevalence of Thyroid Autoimmunity in Women with Recurrent Pregnancy Loss

“…Although the mechanism involved is not clear, three possible explanations for the association of TAI with miscarriage have been proposed: (1) Pregnancy loss is an epiphenomenon and not a direct effect of TAI-the presence of TAI reflects a generalized activation of the immune system and specifically represents an increased reactivity against the fetusplacental unit [11]; (2) The presence of TAI may act as a factor of infertility and may delay conception; therefore, when women with TAI become pregnant, they have an increased risk of miscarriage due to advanced age [12][13][14]; 3The loss of pregnancy may be secondary to a deficiency in thyroid hormone levels or a lower ability of the thyroid to adapt appropriately to pregnancy demands [15,16].…”

Relationship between Thyroid Status during the First Trimester of Pregnancy and Neonatal Well-Being

“…The proper functioning of the thyroid axis is essential for the normal development of the nervous system, especially in the first trimester of gestation when fetal thyroid hormone concentration depends directly on the maternal hormonal contribution. Pregnant women with hypothyroidism are at a higher risk of suffering from preeclampsia, placental abruption, and postpartum hemorrhage, among others [ 3 , 4 , 5 , 6 , 7 ].…”

Cluster Analysis: A New Approach for Identification of Underlying Risk Factors and Demographic Features of First Trimester Pregnancy Women

“…The number and combination of symptoms and signs may indicate a relationship with the diagnosis and treatment of hypothyroidism. Previous studies found a higher rate of 20–40% positive antibodies in hypothyroid pregnancy [ 94 , 96 , 97 ]. Despite the low rate of positive antibodies, new Mexican studies should be conduct for comparison.…”

“…To our knowledge, this is the first application of cluster analysis to identify distinct risk factors and demographic features in a cohort of first-trimester pregnant women with a thyroid profile, a disorder believed to involve multiple disease subtypes [ 87 , 88 , 89 , 90 , 91 ]. Several previous studies analyzed the clinically relevant features and maternal outcomes of hypothyroid and euthyroid pregnancy, leading to new insights about the classification of women with similar patterns [ 92 , 93 , 94 ]. While the impact of these studies contributes to the literature, none of them focus on first trimester pregnancy or risk factor of thyroid pathology.…”