Maternal Subclinical Hyperthyroidism and Adverse Pregnancy Outcomes: A Systematic Review and Meta-analysis of Observational Studies

Abstract

Context: Findings from studies evaluating adverse pregnancy outcomes in pregnant women with subclinical hyperthyroidism are conflicting and inconclusive. Objectives: In this systematic review and meta-analysis, our aim was to evaluatethe pooled odds ratio (OR) of adverse pregnancy outcomes in women with subclinical hyperthyroidism, compared to euthyroid women. Data Sources: Scopus, PubMed (including Medline), and Web of Science databases were systemically searched for regaining published studies to January 2022 examining adverse pregnancy outcomes in women with subclinical hyperthyroidism. Study Selection: Outcomes of interest were classified into seven composite outcomes, including hypertensive disorders, preterm delivery, macrosomia/large for gestational age (LGA), pregnancy loss, adverse maternal outcomes, adverse neonatal outcomes, and adverse fetal outcomes. Data Extraction: In this meta-analysis, both fixed and random effect models were used. Publication bias was also evaluated by Egger test and the funnel plot, and the trim and fill method was conducted in case of a significant result, to adjust the bias. Results: Of 202 records retrieved through searching databases, 11 studies were selected for the final analyses. There were no significant differences in pooled ORs of hypertensive disorders, preterm delivery, macrosomia/LGA, and pregnancy loss in pregnant women with subclinical hyperthyroidism, compared to the euthyroid controls. The pooled OR of adverse maternal, neonatal, and fetal outcomes in pregnant women with subclinical hyperthyroidism was not statistically significantly different from that of the euthyroid control group. Conclusions: The current meta-analysis demonstrated that subclinical hyperthyroidism in pregnancy is not related with adverse maternal and fetal outcomes. Therefore, clinicians should be avoided unnecessary treatments for pregnant women with subclinical hyperthyroidism.

The Thyroid Hormone Axis and Female Reproduction

“…The relationship between subclinical hyperthyroidism and poor outcomes is less clear. While one study reported an increased risk of preeclampsia but not spontaneous abortion [ 138 ], a systematic review identified no increased risk for poor outcomes [ 197 , 214 ].…”

Maternal plasma phospholipid polyunsaturated fatty acids in early pregnancy and thyroid function throughout pregnancy: a longitudinal study

“…GHT results in an imbalance in the concentration of circulating thyroid-stimulating hormone (TSH), T3, and T4, leading to insufficient levels of thyroid hormones [ 7 ]. This condition is associated with adverse maternal outcomes such as preeclampsia and gestational diabetes [ 8 , 9 ], as well as detrimental effects on offspring, including low birth weight and impaired neuro-cognitive development, which can manifest as attention deficit hyperactivity disorder and autism [ [10] , [11] , [12] ].…”