Subclinical Hypothyroidism and Thyroid Autoimmunity Are Not Associated With Fecundity, Pregnancy Loss, or Live Birth

Plowden, Torie C.; Schisterman, Enrique F.; Sjaarda, Lindsey A.; Zarek, Shvetha M.; Perkins, Neil J.; Silver, Robert M.; Galai, Noya; DeCherney, Alan H.; Mumford, Sunni L.

doi:10.1210/jc.2016-1049

Cited by 102 publications

(78 citation statements)

References 26 publications

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“…As such, we utilized inverse probability weights to control for potential selection bias introduced by restricting the analytical cohort since low-dose aspirin treatment was shown to be associated with the probability of pregnancy among women with a single recent loss 13,15,16 . Of note, low dose aspirin treatment was not associated with GDM, PTD, or preeclampsia, and we also did not observe associations between thyroid exposures and pregnancy loss or fecundity 17 . Weights were based on factors associated with becoming pregnant, including maternal age, parity, marital status, number of prior losses, and treatment assignment.…”

Section: Methodscontrasting

confidence: 43%

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: Methodscontrasting

confidence: 43%

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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“…The prevalence of SCH in our study was very high when determined with the 2.5 mIU/L cut‐off (16.7%) and that decreased by more than >70% (to 4.5%) when it was defined according to the institutional cut‐off value. The fact that some recent studies found no association between thyroid dysfunction and altered pregnancy outcomes can also be explained by the use of the 2.5 mIU/L cut‐off value for the diagnosis of SCH . In order to increase the specificity of SCH diagnosis in pregnant women, Korevaar et al .…”

Section: Discussionmentioning

confidence: 99%

Maternal thyroid parameters in pregnant women with different ethnic backgrounds: Do ethnicity‐specific reference ranges improve the diagnosis of subclinical hypothyroidism?

Veltri

Belhomme

Kleynen

et al. 2017

Clinical Endocrinology

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“…The authors had previously shown that there was no relation of pregnancy outcome for TSH values within the normal range [32]. The recent publication by Plowden et al entitled “Subclinical Hypothyroidism and Thyroid Autoimmunity Are Not Associated With Fecundity, Pregnancy Loss, or Live Birth” [33] can be added to this list of clinical evaluations that convey the same message as we did in 2014.…”

Section: Thyroid Function Thyroid Antibodies and Fertilitymentioning

confidence: 67%

A post-publication analysis of the idealized upper reference value of 2.5 mIU/L for TSH: Time to support the thyroid axis with magnesium and iron especially in the setting of reproduction medicine

Moncayo¹,

Moncayo²

2017

BBA Clinical

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Laboratory medicine approaches the evaluation of thyroid function mostly through the single determination of the blood level of thyroid stimulating hormone (TSH). Some authors have suggested an upper reference value for TSH of 2.5 mIU/L. This suggestion has not been confirmed by recent clinical studies. These studies have delivered a clinically valid reference range going from 0.3 to 3.5 mIU/L. These values are valid for both for the general population as well as in the setting of fertility and pregnancy.Current biochemical evidence about the elements required to maintain thyroid function shows that these not only include dietary iodine but also magnesium, iron, selenium and coenzyme Q10. Iron is important for the synthesis of thyroid peroxidase; magnesium-ATP contributes to the active process of iodine uptake; iodine has to be sufficiently present in the diet; selenium acts through selenoproteins to protect the thyroid cell during hormone synthesis and in deiodination of thyroxine; coenzyme Q10 influences thyroid vascularity. As a consequence, good clinical practice requires additional biochemical information on the blood levels of magnesium, selenium, coenzyme Q10 as well as iron status.Since these elements are also important for the maintenance of reproductive function, we postulate that they constitute the connecting link between both endocrine systems.

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Subclinical Hypothyroidism and Thyroid Autoimmunity Are Not Associated With Fecundity, Pregnancy Loss, or Live Birth

Cited by 102 publications

References 26 publications

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

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

Maternal thyroid parameters in pregnant women with different ethnic backgrounds: Do ethnicity‐specific reference ranges improve the diagnosis of subclinical hypothyroidism?

A post-publication analysis of the idealized upper reference value of 2.5 mIU/L for TSH: Time to support the thyroid axis with magnesium and iron especially in the setting of reproduction medicine

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