Maternal hypothyroxinemia in the first trimester of gestation and association with obstetric and neonatal outcomes and iron deficiency: a prospective Brazilian study

Rosário, Pedro Weslley; Oliveira, Luis Fernando Faria; Calsolari, Maria Regina

doi:10.20945/2359-3997000000043

Cited by 10 publications

(21 citation statements)

References 21 publications

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“…The articles were published in various geographical region: North America (15) and USA (14,20)], South America [Brazil (16)], Europe [Netherland (21,24,29), Spain (22), Finland (23) and Ireland (28)] and Asia / Australia [China (6,11,26,27) and Australia (25)]. All studies were prospective or retrospective cohorts and 47% (7/15) had a population-based design (21-23, 26, 27, 29, 30).…”

Section: Search Results Study Selection and Characteristicsmentioning

confidence: 99%

“…However, IMH was not associated with other neonatal outcomes including NICU admission (14,16), low Apgar score (14,15), umbilical artery blood pH < 7 (14), RDS (14), necrotizing enterocolitis (14,16), intraventricular haemorrhage (14,16), major malformations (14,16,25,26), perinatal mortality and neonatal death (14,16,20,25,26), or neurodevelopmental disturbances (26).…”

Section: Neonatal Outcomesmentioning

confidence: 94%

“…Moreover, Su et al (2019), showed that IMH was associated with a 2.2-fold increased risk of gestational HTN (adjusted OR: 2.2, 95% CI: 1.28-3.82) (11). Of 8 studies (6,11,14,16,20,23,25,28) that assessed the association between maternal IMH and placenta abruption, all except one (28), showed no association between IMH and placenta abruption. Two studies assessed the risk of breech presentation in mothers with IMH (6,29) and one (29) reported increased risk of breech presentation in women diagnosed with IMH in the rst trimester of pregnancy (adjusted OR: 4.7, 95% CI: 1.1-19).…”

Section: Feto-maternal Outcomesmentioning

confidence: 99%

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Isolated Maternal Hypothyroxinemia and Adverse Pregnancy Outcomes: A Systematic Review

Tehrani

Nazarpour

Behboudi‐Gandevani

2020

Preprint

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Abstract Background Maternal thyroid hormones are vital for a normal pregnancy and the development of fetus and childhood; inadequate availability of thyroid hormones during pregnancy is associated with adverse pregnancy outcomes. This systematic review aimed to investigate the association between Isolated Maternal hypothyroxinemia (IMH) and adverse pregnancy outcomes. Method: PubMed, Scopus and Web of science were searched for retrieving observational studies published up to September 2019, investigating the association of IMH with adverse pregnancy outcomes. From a total of 267 articles, 15 met our eligibility criteria and were used for the purpose of the present study. Results Definition of IMH varied in different studies. While some studies reported no adverse pregnancy outcomes for IMH, other studies found a positive association between first trimester IMH and feto-maternal outcomes including gestational hypertension, gestational diabetes, preterm delivery, fetal distress, small for gestational age, musculoskeletal malformations, spontaneous abortion, placental abruption and macrosomia. IMH, identified in the second trimester was associated with an increase in the risk of gestational diabetes, and hypertensive disorders of pregnancy in one study. Conclusions There is no consensus on the adverse effects of IMH on pregnancy outcomes. Further comprehensive cohort studies using one standard definition for IMH, with large sample size and control of important confounders such as iodine status and maternal Thyroid peroxidase antibody (TPOAb) are needed for precise assessment of this association.

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Section: Search Results Study Selection and Characteristicsmentioning

confidence: 99%

Section: Neonatal Outcomesmentioning

confidence: 94%

Section: Feto-maternal Outcomesmentioning

confidence: 99%

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Isolated Maternal Hypothyroxinemia and Adverse Pregnancy Outcomes: A Systematic Review

Tehrani

Nazarpour

Behboudi‐Gandevani

2020

Preprint

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“…Two studies reported an association between isolated hypothyroxinemia and iron deficiency anemia; however, they found no associations with negative obstetrical or neonatal outcomes (31,32). In a prospective study of 660 pregnant, Brazilian, TPOAb negative women, Rosario et al found that women with iron deficiency had higher rates of isolated hypothyroxinemia of either free thyroxine (fT4) <0.92 ng/dL, <0.86 ng/dL or TT4<7.8 ng/dL, at 20.7, 14.8, and 17.2%, respectively, compared to women without iron deficiency at 8.4, 3.9, and 6.5%, respectively, P = 0.038, 0.032, and 0.045, respectively, but found no associations between isolated hypothyroxinemia with other obstetrical or neonatal outcomes (32). In a prospective study of 292 pregnant, Georgian women with isolated hypothyroxinemia compared to 58 controls, Morchiladze et al (27) (31).…”

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

confidence: 99%

“…Little was published on the relationship between isolated hypothyroxinemia and adverse pregnancy outcomes when the 2017 ATA Guidelines were published, and this remains true today. Two studies have reported an association between iron deficiency anemia and isolated hypothyroxinemia (31,32), however, there were a large number of tested variables, without correction for the multiple comparisons. Both studies are thus vulnerable to a high risk of false positive findings; therefore, further studies are needed.…”

Section: C) Treatment Of Subclinical Hypothyroidism (Question 37)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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Effects of isolated maternal hypothyroxinemia on adverse pregnancy outcomes

Nazarpour

Tehrani

Rahmati

et al. 2021

Arch Gynecol Obstet

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Maternal hypothyroxinemia in the first trimester of gestation and association with obstetric and neonatal outcomes and iron deficiency: a prospective Brazilian study

Abstract: This prospective Brazilian study found no association between isolated hypothyroxinemia in the first trimester of gestation and obstetric or neonatal outcomes, but an association was demonstrated with iron deficiency.

Cited by 10 publications

References 21 publications

Isolated Maternal Hypothyroxinemia and Adverse Pregnancy Outcomes: A Systematic Review

Isolated Maternal Hypothyroxinemia and Adverse Pregnancy Outcomes: A Systematic Review

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

Effects of isolated maternal hypothyroxinemia on adverse pregnancy outcomes

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