Association between thyroid hormone parameters during early pregnancy and gestational hypertension: a prospective cohort study

Lai, Hua; Zhan, Zhi-Hui; Liu, Huai

doi:10.1177/0300060520904814

Cited by 11 publications

(10 citation statements)

References 25 publications

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“…In addition, our study did not find that SCH increased the incidence of pregnancy-induced hypertension, while Wilson et al 24 and Lai et al 34 showed that the incidence of pregnancy-induced hypertension in SCH was significantly increased. Consistent with our findings, Casey et al 35 found that there was no significant difference in the prevalence of either the incidence of high blood pressure during pregnancy or severe preeclampsia in the first trimester between SCH women and euthyroid women.…”

Section: Discussioncontrasting

confidence: 81%

Impact of TPOAb-negative maternal subclinical hypothyroidism in early pregnancy on adverse pregnancy outcomes

Zhu

Chu

et al. 2021

Therapeutic Advances in Endocrinology

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Purpose: To investigate the effect of subclinical hypothyroidism on pregnancy outcomes of women early in their pregnancy with different thyroid-stimulating hormone levels and thyroid peroxidase antibody–negative status and to explore reasonable thyroid-stimulating hormone levels for subclinical hypothyroidism in early pregnancy. Methods: A total of 2378 women early in their pregnancy were studied retrospectively. The baseline characteristics were collected from medical records. Pregnancy outcomes were compared between the euthyroidism and subclinical hypothyroidism groups that were diagnosed by 2011 or 2017 American Thyroid Association guidelines. In addition, the effect of different maternal thyroid-stimulating hormone levels on adverse pregnancy outcomes was analyzed using binary logistic regression. Results: According to the 2011 American Thyroid Association diagnostic criteria of subclinical hypothyroidism, the prevalence of pregnancy outcomes was not significantly higher in the subclinical hypothyroidism group than in the euthyroidism group. However, pregnant women with subclinical hypothyroidism identified by the 2017 American Thyroid Association criteria had a higher risk of premature delivery (odds ratio = 3.93; 95% confidence interval = 1.22–12.64), gestational diabetes mellitus (odds ratio = 2.69; 95% confidence interval = 1.36–5.32), and gestational anemia (odds ratio = 3.28; 95% confidence interval = 1.60–6.75). Moreover, no differences in the prevalence of adverse pregnancy outcomes were observed between the mildly elevated thyroid-stimulating hormone group (2.5 < thyroid-stimulating hormone ⩽4.0 mIU/l) and the normal thyroid-stimulating hormone group (0.27 < thyroid-stimulating hormone ⩽2.5 mIU/l). The significantly elevated thyroid-stimulating hormone group (4.0 < thyroid-stimulating hormone < 10.0 mIU/l) had a higher prevalence of premature delivery, gestational diabetes mellitus, and gestational anemia than the normal thyroid-stimulating hormone group, even after controlling for potential confounding factors. Conclusion: A mildly elevated thyroid-stimulating hormone level or maternal subclinical hypothyroidism diagnosed by 2011 American Thyroid Association guidelines during early pregnancy in thyroid peroxidase antibody–negative women was not associated with adverse pregnancy outcomes. However, maternal subclinical hypothyroidism identified by the 2017 American Thyroid Association guidelines increased the risks of several adverse pregnancy outcomes in women untreated with levothyroxine. The 2017 American Thyroid Association guidelines could be more reasonable for the diagnosis of subclinical hypothyroidism in southern China.

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Section: Discussioncontrasting

confidence: 81%

Impact of TPOAb-negative maternal subclinical hypothyroidism in early pregnancy on adverse pregnancy outcomes

Zhu

Chu

et al. 2021

Therapeutic Advances in Endocrinology

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“…We then further searched the full texts of 40 articles to assess their eligibility, of which 15 were case-control studies, 2 studies were poorly defined for disease, and 2 studies that did not provide HDP-related data were excluded. Eventually, we included 22 original studies to investigate the relationship between subclinical hypothyroidism in pregnancy and HDP (7,10,11,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). (10)].…”

Section: Search Resultsmentioning

confidence: 99%

“…However, some relevant studies have been published recently, proposing some new conclusions. The results of two recently completed prospective cohort studies indicate that subclinical hypothyroidism in pregnancy is associated with an increased risk of developing HDP and is a risk factor for HDP ( 26 – 31 ). Similarly, the study by Cakmak and Wu, M.Q reached the same conclusion ( 4 , 11 ).…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Subclinical Hypothyroidism in Pregnancy and Hypertensive Disorder of Pregnancy: A Systematic Review and Meta-Analysis

Han

Wang

et al. 2022

Front. Endocrinol.

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ObjectiveStudies have shown a high incidence of subclinical hypothyroidism in pregnancy, but the adverse pregnancy outcomes caused by it are not clear. Therefore, we conducted a systematic review and meta-analysis to evaluate the relationship between subclinical hypothyroidism in pregnancy and hypertensive disorders of pregnancy(HDP) to guide clinical practice.MethodWe searched the MEDLINE (PubMed), Cochrane Central, EMBASE, Web of Science, and SCOPUS databases and screened all studies evaluating the relationship between subclinical hypothyroidism in pregnancy and hypertensive disorders of pregnancy. Two researchers independently evaluated the quality of all eligible original studies using the Newcastle-Ottawa Scale (NOS). We also performed a meta-analysis using STATA15.1. Sensitivity analyses were also performed by examining the effects of individual studies as well as using different effect models and detecting any publication bias using the harbord test.ResultsTwenty-two studies were included in the final meta-analysis. Our results indicated that pregnant women with subclinical hypothyroidism had an increased risk of HDP (OR = 1.54(95% CI: 1.21-1.96) I²=67.1%), compared with euthyroidism. Subclinical hypothyroidism in pregnancy was not associated with hypertensive disorders of pregnancy at TSH diagnostic cut-off of less than 3.0 mIU/L (P = 0.077). Curiously, the risk of HDP increases when the TSH diagnostic cut-off value is higher or lower than 4 mIU/L. Although only 9 studies were above the threshold, the risk of developing HDP was still 1.69 times, which was highest in all subgroup analyses. This is consistent with the newly recommended diagnostic cut-off value of 4 mIU/L for TSH by the ATA. Our results consider that the risk of hypertensive disorder complicating pregnancy is increased regardless of the diagnosis of subclinical hypothyroidism at any stage of pregnancy. Unfortunately, there is insufficient evidence to support that patients can benefit from treatment with levothyroxine.ConclusionThe results of this meta-analysis indicate that subclinical hypothyroidism in pregnancy is associated with an increased risk of developing HDP, and this association exists regardless of the gestational period. However, the available evidence cannot support these patients receiving thyroxine intervention can benefit from it, so routine screening is only recommended for pregnant women with risk factors for hypothyroidism. Further research is needed to validate more scientific and rigorous clinical studies to clarify the relationship between subclinical hypothyroidism and HDP to improve patient prognosis.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, PROSPERO (CRD42021286405)

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“…Specifically, Se deprivation may impair correct function of antioxidant Se-dependent enzymes -glutathione peroxidases and thioredoxin reductases -compromising antioxidant defence pathways, which could lead to endothelial dysfunction observed in the pathophysiology of HDPs (49; 51) . Additionally, Se deficiency could contribute to HDPs by disturbing thyroid function and increasing TSH production (52) which has been suggested as a risk factor for gestational hypertension (53) . Three studies of this review (24; 26; 38) measured Se levels in the first trimester of pregnancy, i.e., before the diagnosis of HDPs (after 20 weeks) took place, and two of them (26; 38) ("good" studies) found a negative association between Se and HDPs.…”

Section: Discussionmentioning

confidence: 99%

The association between selenium levels and hypertensive disorders of pregnancy: a systematic review of the literature

2022

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Selenium (Se) is essential for selenoprotein synthesis, being thus important for immune and thyroid function, and for antioxidant defence. Some studies have shown that low levels of Se may associate with Hypertensive Disorders of Pregnancy (HDPs). Nevertheless, evidence supporting Se supplementation in pregnant or childbearing-age women is still lacking. In this context, this work aimed to systematically review the most recent scientific evidence to understand the relationship between Se levels and HDPs. We performed a systematic review (protocol number: CRD42022310424) with literature of the last decade. PubMed, Scopus, Web of Science, registers, and grey literature were searched to identify studies reporting measurement of Se levels in normotensive and hypertensive pregnant women (supplemented or not with Se). Study quality was assessed using the National Heart, Lung, and Blood Pressure Institute Study Quality Assessment Tools. Among the 30 included studies, a majority, 61% (n=19) of the “good” or “fair” studies, reported a negative association between Se and HDPs, and some studies, 39% (n=11) of the “good” or “fair” studies, reported a lack of association. This review provides an important amount of quality evidence suggesting that low selenium levels associate with the occurrence of HDPs. Nevertheless, the gathered information is not enough to underlie a recommendation for Se supplementation in pregnancy to protect against HDPs. Thus, this review emphasizes the need for further well-designed randomized controlled trials that may provide blunt evidence regarding the benefits of Se supplementation during pregnancy.

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Association between thyroid hormone parameters during early pregnancy and gestational hypertension: a prospective cohort study

Cited by 11 publications

References 25 publications

Impact of TPOAb-negative maternal subclinical hypothyroidism in early pregnancy on adverse pregnancy outcomes

Impact of TPOAb-negative maternal subclinical hypothyroidism in early pregnancy on adverse pregnancy outcomes

Relationship Between Subclinical Hypothyroidism in Pregnancy and Hypertensive Disorder of Pregnancy: A Systematic Review and Meta-Analysis

The association between selenium levels and hypertensive disorders of pregnancy: a systematic review of the literature

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