Maternal Thyroid Disease and Preterm Birth: Systematic Review and Meta-Analysis

Sheehan, Penelope M.; Nankervis, Alison; Júnior, Edward Araujo; Costa, Fabrício da Silva

doi:10.1210/jc.2015-3074

Cited by 101 publications

(85 citation statements)

References 32 publications

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“…In part this may be due to varied definitions of SCH among studies. Our results for PTD are in agreement with findings from a recent systematic review and meta-analysis 18 that reported no relationship between PTD and SCH, though an increased risk of PTD was noted among women with overt hypothyroidism in that study.…”

Section: Commentsupporting

confidence: 92%

Thyroid-stimulating hormone, anti–thyroid antibodies, and pregnancy outcomes

Plowden

Sjaarda

Perkins

et al. 2017

American Journal of Obstetrics and Gynecology

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Background Overt thyroid dysfunction has been associated with adverse obstetrical outcomes. However, less is known regarding subclinical hypothyroidism or thyroid autoimmunity and their relationship to pregnancy complications. Objective To examine the association between pre-pregnancy anti-thyroid antibodies and subclinical hypothyroidism and preterm delivery (PTD), gestational diabetes (GDM), and preeclampsia. Study Design Secondary analysis of a prospective cohort of 18–40 year old women with 1–2 prior pregnancy losses (n=1193) participating in a multi-center randomized, placebo-controlled trial of low-dose aspirin. Pre-pregnancy levels of thyroid stimulating hormone (TSH), free thyroxine, thyroglobulin antibody (anti-TG) and thyroid peroxidase antibody (anti-TPO) were measured. Relative risks (RR) and 95% confidence intervals (CIs) were estimated using generalized linear models adjusting for age and body mass index (BMI). Results Among women with an ongoing pregnancy of >20 weeks estimated gestational age, there was no association between pre-pregnancy TSH level (>2.5 versus ≤2.5 mIU/L) and PTD (aRR 0.77; 95% CI 0.40, 1.47), GDM (aRR 1.28; 95% CI 0.54, 3.04) or preeclampsia (aRR 1.20; 95% CI 0.71, 2.04). Similarly, among women with thyroid antibodies, there was no increase in the likelihood of PTD (RR 1.26; 95% CI 0.65, 2.45), GDM (RR 1.33; 95% CI 0.51, 3.49) or preeclampsia (RR 1.02; 95% CI 0.54, 1.92), compared to women without these antibodies. Conclusions Among women with 1–2 prior pregnancy losses, subclinical hypothyroidism and thyroid autoimmunity were not associated with an increased risk of PTD, GDM, or preeclampsia. These data support current recommendations that low-risk asymptomatic women should not be routinely screened for thyroid dysfunction or autoimmunity.

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Section: Commentsupporting

confidence: 92%

Thyroid-stimulating hormone, anti–thyroid antibodies, and pregnancy outcomes

Plowden

Sjaarda

Perkins

et al. 2017

American Journal of Obstetrics and Gynecology

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“…Given this, the mother has to produce more T4 throughout pregnancy to meet new demands (Krassas et al, 2010), making the balance of maternal thyroid hormones essential - even slight alterations may lead to fetal neurodevelopmental concerns (Boas et al, 2012; Hartoft-Nielsen et al, 2011). Maternal hypothyroidism can also lead to maternal morbidity and adverse birth outcomes; however, the evidence with regards to adverse prenatal health effects due to subclinical hypothyroidism remains unclear (Casey, 2006; Krassas et al, 2010; Sheehan et al, 2015). Due to the complexity in the hypothalamic–pituitary–thyroid axis, thyroid disrupting chemicals could act through several pathways, including hormone synthesis, regulation, transport and metabolism, and/or interference with receptor.…”

Section: Discussionmentioning

confidence: 99%

Phenols and parabens in relation to reproductive and thyroid hormones in pregnant women

Aker

Watkins

Johns

et al. 2016

Environmental Research

155

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Introduction Phenols and parabens are ubiquitous environmental contaminants. Evidence from animal studies and limited human data suggest they may be endocrine disruptors. In the current study, we examined associations of phenols and parabens with reproductive and thyroid hormones in 106 pregnant women recruited for the prospective cohort, “Puerto Rico Testsite for Exploring Contamination Threats (PROTECT)”. Methods Urinary exposure biomarkers (bisphenol A, triclosan, benzophenone-3, 2,4-dichlorophenol, 2,5-dichlorophenol, butyl, methyl and propyl paraben) and serum hormone levels (estradiol, progesterone, sex hormone-binding globulin (SHBG), free triiodothyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormone) were measured at up to two time points during pregnancy (16–20 weeks and 24–28 weeks). We used linear mixed models to assess relationships between exposure biomarkers and hormone levels across pregnancy, controlling for urinary specific gravity, maternal age, BMI and education. In sensitivity analyses, we evaluated cross-sectional relationships between exposure and hormone levels stratified by study visit using linear regression. Results An IQR increase in methyl paraben was associated with a 7.70% increase (95% CI 1.50, 13.90) in SHBG. Furthermore, an IQR increase in butyl paraben as associated with an 8.46% decrease (95% CI 16.92, 0.00) in estradiol, as well as a 9.34% decrease (95% CI −18.31, −0.38) in estradiol/progesterone. Conversely, an IQR increase in butyl paraben was associated with a 5.64% increase (95% CI 1.26, 10.02) in FT4. Progesterone was consistently negatively associated with phenols, but none reached statistical significance. After stratification, methyl and propyl paraben were suggestively negatively associated with estradiol at the first time point (16–20 weeks), and suggestively positively associated with estradiol at the second time point (24–28 weeks). Conclusions Within this ongoing birth cohort, certain phenols and parabens were associated with altered reproductive and thyroid hormone levels during pregnancy. These changes may contribute to adverse health effects in mothers or their offspring, but additional research is required.

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“…Cervical swabs are taken to identify the presence of abnormal flora at each visit, with appropriate antimicrobials offered as indicated. Screening for Chlamydia trachomatis is performed at the first visit, and serum thyroid stimulating hormone (TSH) and alkaline phosphatase (ALP) levels are checked. At the final visit, a fetal fibronectin (fFN) test is performed (Hologic Inc., Marlborough, MA, USA), and women with negative results return to routine antenatal care thereafter.…”

Section: Methodsmentioning

confidence: 99%