Subclinical Hypothyroidism and Pregnancy Outcome – Is There a Relationship?
BACKGROUND AND PURPOSE:
Overt thyroid disease complicates 4% of pregnancy and is associated with adverse outcomes
Little is known regarding the relationship between subclinical hypothyroidism (SCH) or thyroid autoimmunity and adverse pregnancy outcomes
Plowden et al. (AJOG, 2017) examined whether there is an association between prepregnancy anti-thyroid antibodies/subclinical hypothyroidism and obstetric complications
Secondary analysis of prospective cohort study from the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial, a multicenter, double-blind, RCT on the effect of low-dose aspirin on live birth
18-40 year-old women
1-2 previous pregnancy losses
Analysis restricted to women with ongoing pregnancy > 20 weeks
Prepregnancy levels of thyroid-stimulating hormone (TSH), free thyroxine fT4), thyroglobulin antibody (anti-TG), and thyroid peroxidase antibody (anti-TPO) were collected
Levels adjusted for age and body mass index
Participants categorized in to 2 categories: TSH < 2.5 or ≥5 mIU/L
While SCH is usually defined as TSH above the normal range (4.5–5.0 mIU/L) with a normal fT4 level the National Academy of Clinical Biochemistry found that 95% of patients without any symptoms of thyroid dysfunction have a TSH level <2.5 mIU/L
Adjusted for aspirin use because of association with pregnancy in women with single recent loss
Preterm Birth (PTB), defined as delivery between 20w0d and 26w6d
Data was pooled from 1193 women
There was no association between prepregnancy TSH < 2.5 vs ≥5 mIU/L and PTD, GDM or preeclampsia
Among women with thyroid antibodies, there was no association between PTB, GDM or preeclampsia
Authors took in to account whether PTB was medically indicated and there was still no association
Among women with thyroid autoimmunity, there were no differences in PTB, GDM or preeclampsia including whether stratified by TSH level
Previous studies on SCH and preeclampsia show mixed results
Previous studies used higher TSH cut-offs and did not adjusted for BMI
The results from this study are aligned with previous studies on SCH and GDM
This study supports current ACOG recommendations that low-risk asymptomatic women should not be screened routinely for thyroid dysfunction or autoimmunity and patients with SCH and thyroid autoimmunity can be reassured
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