A hospital based retrospective study of thyroid disorders on obstetric and perinatal outcomes

Abstract

Background: The study was undertaken in pregnant women to understand and analyze the obstetric and foetal outcomes of thyroid disorders.Methods: TSH estimation was used as universal screening in their first visit to our hospital. Those patients with abnormal TSH values, i.e. above 2.5 mIU/ml in first trimester and above 3 mIU/ml in second and third trimesters were evaluated for free T3, free T4 and TPO Abs. They were treated accordingly and dosage adjustments made and the tests repeated once in 4-6 weeks. They were followed throughout pregnancy and delivery.Results: Total no of pregnant women screened were 904 over a period of 1 year from 15 March 2019 to 14 March 2020, of which 115 had abnormal thyroid functions, thereby the prevalence of thyroid disorders being 12.72%. Of the 115 patients with thyroid disorders, 112 were hypothyroid and 3 were hyperthyroid. Among the 112 hypothyroid cases, 48 were known cases and 64 were new cases. The total cases of subclinical hypothyroidism were 88, prevalence being 9.73% and overt cases were 24, prevalence being 2.65%; 3 cases were overt hyperthyroid, prevalence being 0.33%. 66% of subclinical hypothyroidism were TPO positive and 34% of overt hypothyroidism were TPO positive (p<0.05). Out of 115 abnormal thyroid function patients, 92 patients delivered in our hospital. There were 15 abortions, 13 spontaneous and 2 terminations of pregnancies; 7 patients have delivered outside and 1 patient lost follow up.Conclusions: The prevalence of thyroid disorders during pregnancy was significantly more in our study, hypothyroidism being the commonest. Significant numbers of cases were newly diagnosed on universal screening. The commonest disorder was subclinical hypothyroidism. Adverse maternal and foetal outcomes were almost similar in both subclinical and overt hypothyroidism. The common adverse outcomes noted were abortions, pre-eclampsia, gestational diabetes mellitus, preterm births and increased rates of caesarean sections. The adverse outcomes were significantly more in autoimmune antibody positive patients.

The effect of thyroid disorders on obstetric and perinatal outcomes: an observational retrospective study in a tertiary care center of north India

“…16 This was in contrast with Patel et al, where LSCS rates (54.34%) were higher in thyroid disorders because of associated complications like pre-eclampsia, gestational diabetes, IUGR and the difference was statistically significant. 5 High rate of caesarean were also present in study by Dhara et al, where 61% of women with thyroid dysfunction underwent LSCS, maximum patients had LSCS in view of bad obstetrical history. 21…”

“…Patel et al, in their retrospective study found out the prevalence of PPROM to be 3.4% and 11.3% of women gave preterm birth. 5 Likewise, Chaudhary et al, found pprom in 5.2% hypothyroid women and preterm labour in 13.3% hypothyroid women, which were significantly more compared to control. 9 In this study, 7% of subclinical hypothyroid women had GDM, 8.5% of overt hypothyroid and 1/10 women in hyperthyroid group had GDM.…”

“…4 Patel et al, found the prevalence of thyroid disorders during pregnancy to be 12.72%, comprising of 9.73% subclinical hypothyroidism, 2.65% overt hypothyroidism and hyperthyroidism in 0.33% women. 5 Murthi et al, observed a prevalence of hypothyroidism of 19.4%. 6 Prevalence of hypothyroidism has wide geographic variations from 2.5% from the West to 11% from India.…”