Gestation-suppressed serum TSH levels during early pregnancy are not associated with altered maternal and neonatal outcomes

Abstract

Objective: To investigate the impact of suppressed serum TSH levels (sTSH) during early pregnancy on maternal and neonatal outcomes. Methods: Single centre, retrospective cohort study in 1081 women screened at 11.8 ± 2.4 weeks of pregnancy for TSH, free T4 (FT4) and TPOAb. Exclusion criteria were twin- and assisted reproduction pregnancies, women with TSH levels >3.74 mIU/L, severe hyperthyroidism, treated for thyroid dysfunction before or after screening and gestational blood sampling <6 or >16 weeks of pregnancy. The prevalence of adverse pregnancy outcomes was compared between the study group sTSH (TSH<0.06 mIU/L; n=36) and euthyroid controls (TSH: 0.06-3.74 mIU/L; n=1045), and the impact of sTSH on pregnancy outcomes verified in logistic regression analyses. Results: Median (IQR range) serum TSH level in women with sTSH was 0.03 (0.03-0.03) vs 1.25 (0.81-1.82) mIU/L in controls and FT4 levels 18.0 (14.4-20.3) vs 14.2 (12.9-15.4) pmol/L; both p<0.001. None of the women with sTSH had thyrotropin receptor antibodies. Compared with controls, the prevalence of TPOAb positivity (TAI) was comparable between groups (5.6% vs 6.6%); p=0.803. The prevalence of maternal and neonatal pregnancy outcomes was comparable between the study and control group. The logistic regression analyses with corrections for TAI, FT4 and demographic parameters confirmed the absence of an association between sTSH, and the following outcomes: iron deficient anaemia (aORs (95% CI)); 1.41 (0.64-2.99); p=0.385, gestational diabetes 1.19 (0.44-2.88); p=0.713, preterm birth 1.57 (0.23-6.22); p=0.574 and low Apgar-1’ score 0.71 (0.11-2.67); p=0.657. Conclusions: Suppressed serum TSH levels during the first to early second trimester of pregnancy were not associated with altered maternal or neonatal outcomes.