Preconception <scp>TSH</scp> and pregnancy outcomes: a population‐based cohort study in 184 611 women

Chen, Shi; Zhou, Xiang; Zhu, Huijuan; Yang, Hongbo; Gong, Fengying; Wang, Linjie; Zhang, Man; Jiang, Yuxin; Yan, Chengsheng; Li, Jianqiang; Wang, Qing; Zhang, Shikun; Pan, Hui

doi:10.1111/cen.13329

Cited by 57 publications

(47 citation statements)

References 34 publications

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“…It has been documented in several studies that high-normal TSH is associated with some adverse effects concerning reproduction and with certain abnormalities in metabolic processes. Concerning the former, either preconception (e.g., Chen et al [8]) or first trimester high-normal TSH (e.g., Hernandez et al, Kianpour et al. [9,10]) are associated with both infertility and unfavorable pregnancy outcomes.…”

Section: Introductionmentioning

confidence: 99%

Less Favorable Lipid Profile and Higher Prevalence of Thyroid Antibodies in Women of Reproductive Age with High-Normal TSH—Retrospective Study

Karbownik-Lewińska

Stępniak

Żurawska

et al. 2020

IJERPH

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High-normal TSH can be associated with metabolic abnormalities and infertility. Aims of this study are to analyze retrospectively if routinely measured blood laboratory and anthropometric parameters differ between women of reproductive age with TSH < 2.5 mIU/L and with TSH ≥ 2.5 mIU/L. Retrospective analysis was performed in 466 female inpatients, aged 13–51, hospitalized in an endocrine department. The group of 280 patients with normal thyroid tests (TSH 0.27-4.2 mIU/L; normal FT3 and FT4) was selected and it was divided into two subgroups, i.e., with TSH < 2.5 mIU/L and TSH ≥ 2.5 mIU/L (n = 66; 23.6%). After excluding patients on L-thyroxine treatment (n = 240), those with TSH ≥ 2.5 mIU/L constituted 22.92% (n = 55). In the group of 280 patients with normal thyroid tests, an abnormally high concentration of triglycerides and an abnormally low HDLC/cholesterol ratio occurred more frequently in women with TSH ≥ 2.5 mIU/L than those with TSH < 2.5 mIU/L (17% vs. 7%, p = 0.017; 14% vs. 5%, p = 0.015, respectively). Increased concentration of thyroid antibodies, i.e., TPOAb, occurred more frequently in patients with TSH ≥ 2.5 mIU/L than those with TSH < 2.5 mIU/L (27% vs. 9%, p = 0.001). The same differences were found in the group of 240 patients after excluding those on L-thyroxine treatment. Blood lymphocyte concentration was the only independent linear parameter associated with TSH ≥ 2.5 mIU/L (OR = 1.551, p = 0.024) but only in the group of 280 patients with normal thyroid tests. TSH concentration correlated positively with blood lymphocyte (r = 0.129, p = 0.031) and TPOAb (r = 0.177, p = 0.005) concentrations but only in the group of 280 patients with normal thyroid tests. Less favorable lipid profiles and a higher prevalence of thyroid antibodies in women of reproductive age with high-normal TSH suggests that L-thyroxine treatment should be considered in such patients. The significance of a positive association between high-normal TSH and blood lymphocytes requires further evaluation.

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Section: Introductionmentioning

confidence: 99%

Less Favorable Lipid Profile and Higher Prevalence of Thyroid Antibodies in Women of Reproductive Age with High-Normal TSH—Retrospective Study

Karbownik-Lewińska

Stępniak

Żurawska

et al. 2020

IJERPH

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“…An example of good practice in this regard is China's national free preconception health examination project which offers access to preconception health examinations including thyroid hormone measurement in rural parts of China ( 14 ). A recent analysis of 184,611 pregnant participants in this programme showed an association between higher preconception TSH concentrations and risks of miscarriages and pre-term loss, highlighting opportunities for modifying pregnancy outcomes with preconception care ( 59 ).…”

Section: Discussionmentioning

confidence: 99%

Thyroid Screening in Early Pregnancy: Pros and Cons

et al. 2018

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Universal thyroid screening in pregnancy is a key debate in thyroidology and obstetrics. It is well-established that thyroid hormones are essential for maintaining pregnancy and optimal fetal development. Thyroid dysfunction is common in women of child-bearing age and also results in substantial adverse obstetric and child neurodevelopmental outcomes. Furthermore, thyroid dysfunction is readily diagnosed with reliable blood tests and easily corrected with inexpensive and available treatments. Screening only high-risk patients appears to miss the majority of cases and economic models show that compared to high-risk screening, universal screening is cost effective even if only overt hypothyroidism was assumed to have adverse obstetric effects. As a result, several countries now implement universal screening. Opponents of universal thyroid screening argue that asymptomatic borderline thyroid abnormalities such as subclinical hypothyroidism and isolated hypothyroxinemia form the bulk of cases of thyroid dysfunction seen in pregnancy and that there is a lack of high quality evidence to support their screening and correction. This review critically appraises the literature, examines the pros and cons of universal thyroid screening using criteria laid down by Wilson and Jungner. It also highlights the growing evidence for universal thyroid screening and indicates the key challenges and practicalities of implementation.

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“…For each of these outcomes, more studies failed to show a significant association with SCH than demonstrating a positive association 9. However, the largest cohort to date published in 2017 showed that women with a single TSH prepregnancy of 4.29–10mU/L (n=7140) had an increased risk of adverse pregnancy outcomes (odds ratio [OR] 1.15, 95% CI 1.10 to 1.22) including spontaneous abortion (OR 1.50, 95% CI 1.32 to 1.70), fetal death (OR 1.58, 95% CI 1.10 to 2.28) and preterm birth (OR 1.20, 95% CI 1.08 to 1.34), even with adjustment for age, body mass index, smoking, thyroid disease and obstetric history 10. Interestingly, an increased risk of adverse events (OR 1.06, 95% CI 1.03 to 1.08) was also shown for women with TSH levels of 2.50–4.28mU/L (n=44 239).…”

Section: Does Sch During Pregnancy Cause Harm?mentioning

confidence: 99%

Management for women with subclinical hypothyroidism in pregnancy

Wiles

2019

DTB

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Preconception TSH and pregnancy outcomes: a population‐based cohort study in 184 611 women

Abstract: Preconception TSH elevation was associated with increased risk of adverse pregnancy outcomes, even within the normal nonpregnant range.

Cited by 57 publications

References 34 publications

Less Favorable Lipid Profile and Higher Prevalence of Thyroid Antibodies in Women of Reproductive Age with High-Normal TSH—Retrospective Study

Less Favorable Lipid Profile and Higher Prevalence of Thyroid Antibodies in Women of Reproductive Age with High-Normal TSH—Retrospective Study

Thyroid Screening in Early Pregnancy: Pros and Cons

Management for women with subclinical hypothyroidism in pregnancy

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