Successful Outcome of Pregnancy in Women with Hypothyroidism

Montoro, Martin; Collea, Joseph V.; Frasier, S. Douglas; Mestman, Jorge H.

doi:10.7326/0003-4819-94-1-31

Cited by 144 publications

(50 citation statements)

References 9 publications

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“…Perinatal outcomes reported in recent investigations (Montoro et al, 1981;Davis et al, 1988;Balen & Kurtz, 1990;Leung et al, 1993) have been more favourable than in earlier studies (Jones & Man, 1969).…”

Section: Discussionmentioning

confidence: 58%

Perinatal consequences of maternal hypothyroidism in early pregnancy and inadequate replacement

Wasserstrum

1995

Clinical Endocrinology

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SummaryMaternal hypothyroidism may be associated with a variety of pregnancy compiicatlons. OBJECTIVE We have evaluated the perinatai consequences of maternal hypothyroidism in early and late gestation. DESIGN Retrospective study of pregnant women, wlth quasl-experlmentai design comparlng dlfferent subJects. SUBJECTS Forty-three pregnancies in 42 women with hypothyroidism -either biochemically hypothyroid or with a history of hypothyroidism on adequate replacement -and no other preexisting medical conditions. MEASUREMENT Free thyroxine index (FTI), TSH, and haematocrit at initial antepartum presentation and near term gestation. Pregnancy outcome variables including: rate of Caesarean section performed for fetal distress in labour, neonatal welght percentlie, and gestational age at blrth. RESULTS Of 42 hypothyroid pregnancies, six were complicated by fetal distress in labour leading to Caesarean section. Five of these six were severely hypothyroid (defined as FTi < 0.6 (normal range 1.1-4.4)) on initial antepartum presentation. in contrast, of the 36 pregnancies without fetal distress, only four initially presented severely hypothyroid (P<0001). Conversely, 56% (519) of .pregnancies which initially presented severely hypothyroid were subsequently complicated by Caesarean section for fetal distress in labour. This compared to 3% (1133) among those who presented either mildly hypothyroid or euthyroid on replacement (P < 00001). Fetal distress correlated with low n l (P < 0001) and high TSH at initial presentation. However, It was independent of FTI near term. A relation between fetal distress and TSH near term did not reach statistical significance. Fetal distress also correlated wlth low maternal haematocrit on admission to labour and delivery (P < 005), but was independent of haematocrit and gestational age at initial presentation, neonatal weight percentile, and gestational age at birth. CONCLUSIONS Severe maternal hypothyroidism early in gestation is strongly assoclated with fetal distress in labour. This suggests that (1) Inadequate maternal replacement leads to fetal distress and (2) maternal thyroid status In early gestation may exert Irreversible effects on the fetus, the placenta, andlor on subsequent maternal adaptations to pregnancy. Early adequate replacement therapy is especially prudent in pregnant women presenting with severe hypothyroidism.

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Section: Discussionmentioning

confidence: 58%

Perinatal consequences of maternal hypothyroidism in early pregnancy and inadequate replacement

Wasserstrum

1995

Clinical Endocrinology

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“…1 7 Neither of these earlier studies linked TSH measurements with pregnancy complications or outcome in the entire cohort. Other studies suggested that adverse events such as fetal death, premature birth, low birthweight, placental abruption, and pregnancy induced hypertension [8][9][10][11] occur more often in women with clinically diagnosed hypothyroidism. These observations, however, have been limited to women attending high risk or specialty clinics and may not reflect findings in the general population.…”

Section: Discussionmentioning

confidence: 99%

Maternal thyroid deficiency and pregnancy complications: implications for population screening

et al. 2000

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Objective-To examine the relation between certain pregnancy complications and thyroid stimulating hormone (TSH) measurements in a cohort of pregnant women. Methods-TSH was measured in sera obtained from women during the second trimester as part of routine prenatal care. Information was then collected about vaginal bleeding, premature delivery, low birthweight, abruptio placentae, pregnancy induced hypertension, need for cesarean section, low Apgar scores, and fetal and neonatal death. Results-Among 9403 women with singleton pregnancies, TSH measurements were 6 mU/l or greater in 209 (2.2%). The rate of fetal death was significantly higher in those pregnancies (3.8%) than in the women with TSH less than 6 mU/l (0.9%, odds ratio 4.4, 95% confidence interval 1.9-9.5). Other pregnancy complications did not occur more frequently Conclusion-From the second trimester onward, the major adverse obstetrical outcome associated with raised TSH in the general population is an increased rate of fetal death. If thyroid replacement treatment avoided this problem this would be another reason to consider population screening. (J Med Screen 2000;7:127-130) Keywords: thyroid stimulating hormone; pregnancy; fetal death Although clinically apparent maternal hypothyroidism during pregnancy has long been known to be associated with both maternal and fetal complications, most of the studies documenting those problems have focused on patients in specialty or high risk clinics. The present study assesses the impact of maternal hypothyroidism in a cohort of pregnant women being managed in primary care settings. In 1991, our group reported thyroid stimulating hormone (TSH) measurements in a cohort of 2000 pregnant women whose sera were being obtained for -fetoprotein measurements at 15-18 weeks' gestation as part of routine care. 1 TSH measurements were at, or above, 6 mU/l in 49 of the women (2.4%). In six of these 49 women the thyroxine (T 4 ) and/or free T 4 measurements were suYciently abnormal (more than two standard deviations below the average) for clinical manifestations to be anticipated. It was not possible to gather individual information about health status in this cohort, because all identifiers were removed from the serum samples before the thyroid measurements were performed. Given the frequency of thyroid deficiency identified in this pregnancy population, it was decided that its possible impact on late pregnancy and delivery should be evaluated. To accomplish this, it was necessary to study a second, larger cohort of pregnant women. Materials and methodsThe Foundation for Blood Research oVers prenatal serum screening services for open neural tube defects and Down's syndrome to all primary care prenatal practices in Maine. The testing is generally performed between 15 and 18 weeks' gestation. Approximately two thirds of the women receiving prenatal care in Maine opt for those services.Between July 1990 and June 1992 the order form for the prenatal screening test contained a supplementary consent form, asking women...

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“…Dijstra et al (5) reported disturbed folliculogenesis and absence of corpora lutea when hypothyroidism was induced since birth. In women, hypothyroidism is associated with delay in the onset of puberty (6), anovulation (7), amenorrhea or hypermenorrhea, menstrual irregularity, infertility and increased frequency of spontaneous abortions (8)(9)(10). It was suggested that these alterations may be caused by a decrease in LH secretion.…”

Section: Introductionmentioning

confidence: 99%

Is the infertility in hypothyroidism mainly due to ovarian or pituitary functional changes?

Armada-Dias

Carvalho

Breitenbach

et al. 2001

Braz J Med Biol Res

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The objective of the present study was to examine whether hypothyroidism affects the reproductive system of adult female rats by evaluating ovarian morphology, uterus weight and the changes in serum and pituitary concentrations of prolactin and gonadotropins. Three-monthold female rats were divided into three groups: control (N = 10), hypothyroid (N = 10), treated with 0.05% 6-propyl-2-thiouracil (PTU) in drinking water for 60 days, and T 4 -treated group (N = 10), receiving daily sc injections of L-thyroxine (0.8 µg/100 g body weight) during the last 10 days of the experiment. At the end of 50 days of hypothyroidism no hypothyroid animal showed a regular cycle, while 71% of controls as well as the T 4 -treated rats showed regular cycles. Corpora lutea, growing follicles and mature Graafian follicles were found in all ovaries studied. The corpora lutea were smaller in both the hypothyroid and T 4 -replaced rats. Graafian follicles were found in 72% of controls and only in 34% of hypothyroid and 43% of T 4 -treated animals. Serum LH, FSH, progesterone and estradiol concentrations did not differ among the three groups. Serum prolactin concentration and the pituitary content of the three hormones studied were higher in the hypothyroid animals compared to control. T 4 treatment restored serum prolactin concentration to the level found in controls, but only partially normalized the pituitary content of gonadotropins and prolactin. In conclusion, the morphological changes caused by hypothyroidism can be a consequence of higher prolactin production that can block the secretion and action of gonadotropins, being the main cause of the changes observed.

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Successful Outcome of Pregnancy in Women with Hypothyroidism

Cited by 144 publications

References 9 publications

Perinatal consequences of maternal hypothyroidism in early pregnancy and inadequate replacement

Perinatal consequences of maternal hypothyroidism in early pregnancy and inadequate replacement

Maternal thyroid deficiency and pregnancy complications: implications for population screening

Is the infertility in hypothyroidism mainly due to ovarian or pituitary functional changes?

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