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Grand Rounds

Is Preconception Thyroid Function Associated with Adverse Birth Weight Outcomes?

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BACKGROUND AND PURPOSE:

  • Du et al. (The Journal of Clinical Endocrinology & Metabolism, 2022) focus on the impact of preconception maternal TSH and pregnancy outcomes

METHODS:

  • Population-based cohort study
    • National Free Preconception Checkups Project in China
  • Population
    • Pregnancies between 2010 to 2012
  • Exposures
    • Maternal TSH level in 6 months before pregnancy
  • Study design
    • Regression models used to
      • Examine dose-response relationships
      • Estimate potential optimal cutoff values
    • Logistic regression was used to assess the relationship between different TSH groups and the risk of adverse outcomes
  • Primary outcome
    • Pregnancy outcomes (e.g., stillbirth, preterm birth)
    • Birth weight outcomes (e.g., small for gestational age [SGA], large for gestational age [LGA], low birth weight [LBW})

RESULTS:

  • 175,112 women
  • Lower preconception TSH was associated with a higher odds of
    • LBW (P=0.003)
    • Preterm delivery (P<0.001)
  • There was no significant association between preconception TSH and
    • SGA
    • Macrosomia
    • Fetal anomalies
    • Stillbirth
    • Natural or induced abortion
    • Cesarean delivery
  • Compared with TSH levels between 0.91 to 1.82 mIU/L, low and high levels of TSH were associated with a higher risk of preterm delivery and LGA
    • Low levels: < 0.40 mIU/L | 0.40 to 0.90 mIU/L
    • High levels: 1.83 to 2.49 mIU/L | 2.50 to 3.99 mIU/L | >4.00 mIU/L
  • There was no significant association between TSH groups and the risk for LBW, except for TSH < 0.40 mIU/L

CONCLUSION:

  • Preconception TSH levels were associated with increased risks LGA, LBW, and preterm delivery
  • Both high and low levels of preconception TSH (J-curve) were associated with an increased risk of preterm delivery and large for gestational age
  • Preconception TSH levels between 0.91 to 1.82 mIU/L appears to be an optimal range for avoiding adverse pregnancy outcomes

Learn More – Primary Sources:

Preconception TSH and Adverse Pregnancy Outcomes in China: A Nationwide Prospective Cohort Study

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Related ObG Topics:

Childhood Brain Development: Is There a Critical Window for Maternal TSH Measurement?
Subclinical Hypothyroidism and Pregnancy Outcome – Is There a Relationship?
Are Thyroid Test Abnormalities a Risk Factor for Preterm Birth?
Meta-Analysis: Does Maternal Thyroid Dysfunction Increase the Risk for Preeclampsia?

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