Pregnancy Complications Associated With Maternal Hypothyroidism: A Systematic Review

Shinohara, Danielle Rosani; Santos, Thaís da Silva; Carvalho, Hayalla Corrêa de; Lopes, Laíza Cristina Bahls; Günther, Luciene Setsuko Akimoto; Aristides, Sandra Mara Alessi; Teixeira, Jorge Juarez Vieira; Demarchi, Izabel Galhardo

doi:10.1097/ogx.0000000000000547

Cited by 40 publications

(25 citation statements)

References 33 publications

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“…In this population-based study, our results strengthen the notion of the association between hypothyroidism and GH. 16 Thyroid hormones are essential for maintaining homeostasis as evidenced by the myriad effects of thyroid hormone deficiency. Hypothyroidism significantly interferes with the cardiovascular system, leading to changes in left ventricular function, decreased cardiac output, and increased systemic vascular resistance.…”

Section: Discussionmentioning

confidence: 99%

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

2020

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Objective: Thyroid dysfunction may play a role in the development of gestational hypertension. However, this relationship remains unclear. This study was performed to evaluate the association between thyroid hormone parameters during early pregnancy and gestational hypertension. Methods: Women with singleton pregnancies were recruited into this prospective cohort study at 9 to 13 gestational weeks, and their serum thyroid-stimulating hormone, free thyroxine, and free triiodothyronine concentrations were measured using electrochemiluminescence immunoassays. In total, 1226 participants were included in the final analysis. Results: Of the 1226 participants, 81 subsequently developed gestational hypertension (overall incidence of 6.6%). Compared with women with euthyroidism, both pregnant women with hypothyroidism and those with subclinical hypothyroidism had an increased risk of gestational hypertension (adjusted odds ratio [OR], 3.61; 95% confidence interval [CI], 1.52-8.57 and OR, 2.24; 95% CI, 1.06-4.72, respectively). When the thyroid-stimulating hormone and free thyroxine concentrations were analyzed by quintiles, the women in the highest thyroid-stimulating hormone quintile had a higher risk of gestational hypertension (adjusted OR, 4.22; 95% CI, 1.78-9.05) than the women in the middle quintile. Conclusion: Our results suggest that hypothyroidism, subclinical hypothyroidism, and a high thyroid-stimulating hormone concentration during early pregnancy are risk factors for gestational hypertension.

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Section: Discussionmentioning

confidence: 99%

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

2020

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“…Hypothyroidism is known to be one of the causes of hypertension [6]. Both untreated subclinical hypothyroidism and overt hypothyroidism are associated with multiple adverse outcomes in the mother and fetus [3,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Women with treated hypothyroid diseases are not at higher risk than healthy pregnant women for adverse neonatal outcomes, but may also be at increased risk for preeclampsia [24].…”

Section: Introductionmentioning

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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“…(1) Por su parte, el hipotiroidismo clínico puede presentar síntomas inespecíficos como debilidad, letargia, intolerancia al frío, edema, estreñimiento y aumento de peso no atribuible a la gestación. (2,(7)(8) Esto conlleva a que el diagnóstico y tratamiento de esta patología represente un reto para el clínico. Por lo anterior, el objetivo de esta revisión es presentar la información más actualizada sobre los cambios fisiológicos en la función tiroidea, complicaciones asociadas, además del tamizaje, diagnóstico y tratamiento del hipotiroidismo durante el embarazo.…”

Section: Introductionunclassified

“…Se ha visto que el riesgo de pérdida gestacional aumenta proporcionalmente al grado de elevación de la TSH. (12-13) Asimismo, se han reportado complicaciones infrecuentes como polihidramnios, oligohidramnios, hiperémesis gravídica, diabetes mellitus gestacional, ruptura prematura de membranas e hipertensión crónica (8). Es esperable que las mujeres embarazadas con un adecuado control tengan un menor riesgo de estas complicaciones; mas no hay estudios que lo demuestren, debido a razones éticas.…”

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“…Es esperable que las mujeres embarazadas con un adecuado control tengan un menor riesgo de estas complicaciones; mas no hay estudios que lo demuestren, debido a razones éticas. Sin embargo, las guías clínicas de la ATA y el Colegio Estadounidense de Obstetras y Ginecólogos sí recomiendan iniciar o ajustar el tratamiento con levotiroxina para evitar complicaciones obstétricas (1,(7)(8)(9).…”

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Hipotiroidismo Durante El Embarazo

Rodríguez

Figueroa

Vindas

2021

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Resumen Las enfermedades tiroideas están entre los trastornos endocrinos más frecuentemente reportados durante el embarazo, en parte debido a los cambios fisiológicos que ocurren principalmente en el primer trimestre. En pacientes embarazadas, el hipotiroidismo clínico tiene una prevalencia de 0.3-1.9%, mientras que el hipotiroidismo subclínico de 1.5-5%. Estos porcentajes dependen de diferentes variables como la ingesta de yodo. Se ha visto que el hipotiroidismo generalmente representa un riesgo para la unidad materno-fetal, por lo que se debe tener en cuenta el rango de referencia trimestral de TSH según la población para realizar un diagnóstico apropiado. El tratamiento consiste en levotiroxina oral, según las metas establecidas. Además, la captación de aquellas pacientes que presenten factores de riesgo, así como aquellas con diagnóstico previo de hipotiroidismo permite darles el seguimiento adecuado. Por lo anterior, es necesario que los diferentes servicios cuenten con bases de datos a nivel regional o nacional para establecer rangos de referencia trimestrales específicos para la población.

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Pregnancy Complications Associated With Maternal Hypothyroidism: A Systematic Review

Cited by 40 publications

References 33 publications

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

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

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

Hipotiroidismo Durante El Embarazo

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