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OBJECTIVE To estimate whether maternal thyroid hypofunction is associated with complications. METHODS A total of 10,990 patients had first- and second-trimester serum assayed for thyroid-stimulating hormone (TSH), free thyroxine (freeT4), and antithyroglobulin and antithyroid peroxidase antibodies. Thyroid hypofunction was defined as 1) subclinical hypothyroidism: TSH levels above the 97.5th percentile and free T4 between the 2.5th and 97.5th percentiles or 2) hypothyroxinemia: TSH between the 2.5th and 97.5th percentiles and free T4 below the 2.5th percentile. Adverse outcomes were evaluated. Patients with thyroid hypofunction were compared with euthyroid patients (TSH and free T4 between the 2.5th and 97.5th percentiles). Patients with and without antibodies were compared. Multivariable logistic regression analysis adjusted for confounders was used. RESULTS Subclinical hypothyroidism was documented in 2.2% (240 of 10,990) in the first and 2.2% (243 of 10,990) in the second trimester. Hypothyroxinemia was documented in 2.1% (232 of 10,990) in the first and 2.3% (247 of 10,990) in the second trimester. Subclinical hypothyroidism was not associated with adverse outcomes. In the first trimester, hypothyroxinemia was associated with preterm labor (adjusted odds ratio [aOR] 1.62; 95% confidence interval [CI] 1.00–2.62) and macrosomia (aOR 1.97; 95% CI 1.37–2.83). In the second trimester, it was associated with gestational diabetes (aOR 1.7; 95% CI 1.02–2.84). Fifteen percent (1,585 of 10,990) in the first and 14% (1,491 of 10,990) in the second trimester had antithyroid antibodies. When both antibodies were positive in either trimester, there was an increased risk for preterm premature rupture of membranes (P = .002 and P<.001, respectively). CONCLUSION Maternal thyroid hypofunction is not associated with a consistent pattern of adverse outcomes. LEVEL OF EVIDENCE: II

Abstract-The potential benefits and risks of physical activity before and during pregnancy are not well studied. We studied the relation between recreational physical activity and the risk of preeclampsia in a case-control study of 201 preeclamptic and 383 normotensive pregnant women. Participants provided information about the type, intensity, frequency, and duration of physical activity performed during the first 20 weeks of pregnancy and during the year before pregnancy. Women who engaged in any regular physical activity during early pregnancy, compared with inactive women, experienced a 35% reduced risk of preeclampsia (odds ratio, 0.65; 95% confidence interval [CI], 0.43 to 0.99).Compared with inactive women, those engaged in light or moderate activities (ie, activities with metabolic-equivalent scores Ͻ6) experienced a 24% reduced risk of preeclampsia (95% CI, 0.48 to 1.20). The corresponding reduction for women participating in vigorous activities (metabolic equivalent scores Ն6) was 54% (95% CI, 0.27 to 0.79). Brisk walking (average walking pace Ն3 mi/h), when compared with no walking at all, was associated with a 30% to 33% reduction in preeclampsia risk. Stair climbing was inversely associated with the risk of preeclampsia (P for trendϭ0.039). Recreational physical activity performed during the year before pregnancy was associated with similar reductions in preeclampsia risk. These data suggest that regular physical activity, particularly when performed during the year before pregnancy and during early pregnancy, is associated with a reduced risk of preeclampsia. Key Words: exercise Ⅲ pregnancy Ⅲ preeclampsia Ⅲ hypertension, pregnancy H ypertensive disorders during pregnancy are the second leading cause, after embolism, of maternal mortality in the United States, accounting for Ϸ15% of such deaths. 1 Hypertension in pregnancy is associated with complications, including abruptio placentae, cerebral hemorrhage, hepatic failure, and acute renal failure. 2 Preeclampsia, 1 of the hypertensive disorders, occurs in 3% to 4% of pregnancies and contributes to perinatal morbidity and mortality. Little is known about the occurrence of preeclampsia in relation to modifiable risk factors, such as recreational physical activity. Although the health benefits of recreational physical activity, such as reductions in the risk of essential hypertension, coronary heart disease, and type 2 diabetes are well documented, 3 surprisingly little is known about the relation between maternal physical activity and the risk of hypertensive disorders of pregnancy. More than a decade ago, Marcoux et al, 4 in their case-control study of Canadian women, reported that women who regularly participated in recreational physical activity during the first 20 weeks of pregnancy experienced a 43% reduction in risk of preeclampsia compared with sedentary women. The authors did not study the risk of preeclampsia in relation to maternal physical activity before pregnancy, nor did they evaluate the impact of typical daily activities, such as walki...

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These data suggest that components of the quad screen may prove useful in predicting adverse obstetric outcomes. We also showed that the total number and specific combinations of abnormal markers are most useful in predicting the risk of adverse perinatal outcome.