Impact of <scp>TSH</scp> during the first trimester of pregnancy on obstetric and foetal complications: Usefulness of 2.5 <scp>mIU</scp>/L cut‐off value

Hernández, Marta; López, Carolina Martínez; Soldevila, Berta; Cecenarro, Laura Anahi; Martinez-Barahona, Maria; Palomera, Elísabet; Rius, Ferrán; Lecube, Albert; Pelegay, Maria Jose; García, Jordi; Mauricio, Dı́dac; Puig-Domingo, Manel

doi:10.1111/cen.13575

Cited by 27 publications

(17 citation statements)

References 20 publications

(25 reference statements)

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“…Concerning the former, either preconception (e.g., Chen et al [8]) or first trimester high-normal TSH (e.g., Hernandez et al, Kianpour et al. [9,10]) are associated with both infertility and unfavorable pregnancy outcomes. Concerning other undesired effects, the association between high-normal TSH and an abnormal lipid profile was described, for example, in euthyroid non-smokers with newly diagnosed heart disease [11] and in women of childbearing age [12].…”

Section: Introductionmentioning

confidence: 99%

Less Favorable Lipid Profile and Higher Prevalence of Thyroid Antibodies in Women of Reproductive Age with High-Normal TSH—Retrospective Study

Karbownik-Lewińska

Stępniak

Żurawska

et al. 2020

IJERPH

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High-normal TSH can be associated with metabolic abnormalities and infertility. Aims of this study are to analyze retrospectively if routinely measured blood laboratory and anthropometric parameters differ between women of reproductive age with TSH < 2.5 mIU/L and with TSH ≥ 2.5 mIU/L. Retrospective analysis was performed in 466 female inpatients, aged 13–51, hospitalized in an endocrine department. The group of 280 patients with normal thyroid tests (TSH 0.27-4.2 mIU/L; normal FT3 and FT4) was selected and it was divided into two subgroups, i.e., with TSH < 2.5 mIU/L and TSH ≥ 2.5 mIU/L (n = 66; 23.6%). After excluding patients on L-thyroxine treatment (n = 240), those with TSH ≥ 2.5 mIU/L constituted 22.92% (n = 55). In the group of 280 patients with normal thyroid tests, an abnormally high concentration of triglycerides and an abnormally low HDLC/cholesterol ratio occurred more frequently in women with TSH ≥ 2.5 mIU/L than those with TSH < 2.5 mIU/L (17% vs. 7%, p = 0.017; 14% vs. 5%, p = 0.015, respectively). Increased concentration of thyroid antibodies, i.e., TPOAb, occurred more frequently in patients with TSH ≥ 2.5 mIU/L than those with TSH < 2.5 mIU/L (27% vs. 9%, p = 0.001). The same differences were found in the group of 240 patients after excluding those on L-thyroxine treatment. Blood lymphocyte concentration was the only independent linear parameter associated with TSH ≥ 2.5 mIU/L (OR = 1.551, p = 0.024) but only in the group of 280 patients with normal thyroid tests. TSH concentration correlated positively with blood lymphocyte (r = 0.129, p = 0.031) and TPOAb (r = 0.177, p = 0.005) concentrations but only in the group of 280 patients with normal thyroid tests. Less favorable lipid profiles and a higher prevalence of thyroid antibodies in women of reproductive age with high-normal TSH suggests that L-thyroxine treatment should be considered in such patients. The significance of a positive association between high-normal TSH and blood lymphocytes requires further evaluation.

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Section: Introductionmentioning

confidence: 99%

Less Favorable Lipid Profile and Higher Prevalence of Thyroid Antibodies in Women of Reproductive Age with High-Normal TSH—Retrospective Study

Karbownik-Lewińska

Stępniak

Żurawska

et al. 2020

IJERPH

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“…It might be due to the small sample size of our study or the racial differences of different studies. Many studies focused only on the first trimester [9,19,25,39,40], and did not include all preeclampsia types [41]. The present study investigated thyroid hormones of women with gestational hypertension in the second half trimester and compared various types of preeclampsia according to the severity and the gestational age.…”

Section: Discussionmentioning

confidence: 99%

Association between thyroid dysfunction and perinatal outcomes in women with gestational hypertension: a retrospective study

Gui

Zhang

2020

BMC Pregnancy Childbirth

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Background: Previous studies showed that thyroid dysfunction in women with gestational hypertension could negatively affect maternal and fetal outcomes. In this study, we aimed to investigate whether thyroid dysfunction assessed in the second half trimester contributed to neonatal outcomes of pregnancy in different subtypes of gestational hypertension disease. Methods: We performed a retrospective case-control study and collected data from 135 singleton pregnant women with gestational hypertension disease and their offspring who delivered in Renmin Hospital of Wuhan University from January 2015 to June 2017. We classified the patients based on the severity of the preeclampsia into three groups: pregnant induced hypertension (PIH), mild preeclampsia (MPE) and severe preeclampsia (SPE). Based on the onset time of preeclampsia, we classified the patients into PIH, early onset preeclampsia (EPE) and late onset preeclampsia. Demographic data and levels of thyroid hormones, as well as the adverse maternal and neonatal outcomes were collected from Electronic Medical Records. Logistic regression was used to estimate the associations between thyroid dysfunction and neonatal outcomes in these patients. Results: Gestational weeks and neonatal birthweight were significantly lower, while incidence of preterm birth was significantly higher in the SPE and EPE groups than those in the PIH group (P < 0.001). Thyroid dysfunction was more frequent in the SPE group than in the MPE group (P = 0.01). Incidences of both preterm birth and low birth weight were significantly higher in patients with thyroid dysfunction (P = 0.008, P = 0.047 respectively). After adjustment, both severity of gestational hypertension (OR = 4.360, 95%CI [2.050, 9.271], P < 0.001; OR = 4.023, 95%CI [1.933, 8.372], P < 0.001) and thyroid dysfunction (OR = 3.011, 95%CI [1.248, 7.262], P = 0.014; OR = 11.306, 95%CI [1.040, 122.889], P = 0.046) were associated with higher risk of preterm birth and low birth weight, while the onset time of preeclampsia (OR = 0.031, 95%CI [0.009, 0.110], P < 0.001; OR = 0.097, 95%CI [0.033, 0.282], P < 0.001) was negatively associated with the risk of preterm birth and low birth weight. Conclusion: Severe and early onset preeclampsia, as well as thyroid dysfunction are associated with higher risk of preterm birth and low neonatal birth weight. Therefore, our data suggest that monitoring thyroid hormones in women with preeclampsia might help to predict adverse neonatal outcomes.

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“…It was still unclear whether L-T4 treatment decreases the effects of TAI on fertility and pregnancy outcome in infertile women. We therefore evaluated the effects of TAI on pregnancy under treatment with L-T4 for infertile women with TSH levels Recently, some benefits of L-T4 supplementation for SCH women with TSH levels above 2.5 μIU/mL have been reported; miscarriage and premature birth are reportedly decreased [21,22], and others have reported reduction of miscarriage in infertile women with ART [14]. In 2017 ATA guidelines, L-T4 supplementation for women undergoing ART with TSH levels above 2.5 μIU/mL is recommended [10], but the risk factors of miscarriage under L-T4 treatment had not been explored.…”

Section: Discussionmentioning

confidence: 99%

The influence of thyroid autoimmunity on pregnancy outcome in infertile women: a prospective study

et al. 2020

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Thyroid dysfunction and thyroid autoimmunity (TAI) have been reported to be linked to infertility, pregnancy loss and preterm birth. Infertile women undergoing assisted reproductive technology are recommended to maintain thyroid stimulating hormone (TSH) levels below 2.5 μIU/mL. It is unclear, however, whether levothyroxine (L-T4) treatment decreases the effects of TAI on fertility and pregnancy outcome in infertile women. We therefore aimed to clarify the influence of TAI on pregnancy undergoing L-T4 treatment for hypothyroidism. Prospectively recruited to this study were the 595 infertile women who visited the Utsunomiya Ladies Clinic between January 2013 and December 2015. Five patients with Graves' disease were excluded. Clinical profiles of 590 women were as follows: proportion of SCH = 19.6%, thyroid peroxidase antibody (TPOAb) positivity = 10.4%, and thyroglobulin antibody (TgAb) positivity = 15.1%. Fertility was not affected by any thyroid-associated factors. Regarding pregnancy outcomes, TPOAb titers were significantly higher in women who had miscarriage than in those progressed to delivery (46.4 ± 114.1 vs. 18.9 ± 54.6 IU/mL, p = 0.039), notably in those undergoing intrauterine insemination (p = 0.046) and in vitro fertilization (p = 0.023). Multivariate logistic regression analysis revealed that higher age (odds ratio 26.4, p < 0.001) and higher TPOAb titer (odds ratio 11.8, p = 0.043) were risk factors for miscarriage. Higher TPOAb titer should be considered as one of the risk factors for miscarriage in infertile women, even if they have been treated with L-T4 for hypothyroidism.

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Impact of TSH during the first trimester of pregnancy on obstetric and foetal complications: Usefulness of 2.5 mIU/L cut‐off value

Abstract: There is a positive association between maternal TSH in the first trimester of pregnancy and the incidence of perinatal loss and miscarriage. The TSH cut-off value of 2.5 mIU/L identified women with higher adverse pregnancy outcomes.

Cited by 27 publications

References 20 publications

Less Favorable Lipid Profile and Higher Prevalence of Thyroid Antibodies in Women of Reproductive Age with High-Normal TSH—Retrospective Study

Less Favorable Lipid Profile and Higher Prevalence of Thyroid Antibodies in Women of Reproductive Age with High-Normal TSH—Retrospective Study

Association between thyroid dysfunction and perinatal outcomes in women with gestational hypertension: a retrospective study

The influence of thyroid autoimmunity on pregnancy outcome in infertile women: a prospective study

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