Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis

Maraka, Spyridoula; Ospina, Naykky M Singh; O’Keeffe, Derek; Ycaza, Ana E. Espinosa De; Gionfriddo, Michael R.; Erwin, Patricia J.; Coddington, Charles C.; Stan, Marius N.; Murad, M. Hassan; Montori, Víctor M.

doi:10.1089/thy.2015.0418

Cited by 308 publications

(248 citation statements)

References 48 publications

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“…SCH adversely affects obstetric outcomes with increasing pregnancy loss, premature delivery, and gestational hypertension (Chen et al 2014;Maraka et al 2016). On the other hand, SCH detected at the first trimester was not associated with adverse pregnancy outcomes after 20 weeks (Ong et al 2014).…”

Section: Discussionmentioning

confidence: 99%

“…According to a recent review, SCH adversely affects obstetric outcomes including increasing pregnancy loss, premature delivery, and gestational hypertension (Maraka et al 2016). In contrast, it was reported that in a prospective cohort study of pregnant women, SCH at the first trimester was not associated with adverse pregnancy outcomes after 20 weeks (Ong et al 2014).…”

Section: Introductionmentioning

confidence: 99%

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Women with Subclinical Hypothyroidism Are at Low Risk of Poor Pregnancy Outcome in Japan

Furukawa

Miyakawa

Shibata

et al. 2017

Tohoku J. Exp. Med.

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Maternal subclinical hypothyroidism may be associated with adverse pregnancy outcomes, although not consistently across regions. Here, we sought to determine the effect of elevated thyroid-stimulating hormone (TSH) on pregnancy outcomes in Japanese women without known medical complications. TSH was determined by dried blood spots at 8-20 weeks of gestation, and 3.0-10.0 μ U/mL of TSH was considered as elevated TSH (eTSH). A retrospective study involving 167 cases of eTSH was conducted. Five hundred and seventy eight of controls with normal TSH and without thyroid antibodies were selected. We compared a composite adverse maternal outcome comprised of spontaneous abortion, premature delivery, gestational diabetes mellitus (GDM), placental abruption, and pregnancy-induced hypertension, as well as composite adverse neonatal outcome including stillbirths, heavy for date, light for date, and a low Apgar score (< 7) at 5 minutes between two groups. The incidence of GDM was significantly higher in eTSH (p < 0.01); however, composite adverse maternal and neonatal outcome did not differ between groups (p = 0.19 and p = 0.50, respectively). Although 27 out of 167 cases in eTSH have antibodies, composite adverse outcome did not differ between eTSH with antibodies and controls (p = 0.64 and p = 0.50, respectively). Additionally, composite adverse maternal and neonatal outcome did not differ between the group larger than the median of TSH in eTSH (n = 81) and controls (p = 0.43 and p = 0.98, respectively). Thus, elevated TSH is not associated with overall adverse pregnancy outcomes in women without known medical complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Women with Subclinical Hypothyroidism Are at Low Risk of Poor Pregnancy Outcome in Japan

Furukawa

Miyakawa

Shibata

et al. 2017

Tohoku J. Exp. Med.

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“…Publication bias may have affected these reports, as negative studies are less likely to be published. Moreover, the vast majority of the studies assessing the impact of SCH in pregnancy are at low to moderate risk of bias, warranting less confidence in their results due to small samples, imprecision in the estimates, and failure to adjust for confounding factors (11,12).…”

mentioning

confidence: 99%

Effects of Levothyroxine Therapy on Pregnancy Outcomes in Women with Subclinical Hypothyroidism

Maraka

Ospina

O’Keeffe

et al. 2016

Thyroid

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Background: Subclinical hypothyroidism (SCH) has been associated with increased risk of adverse pregnancy outcomes in some, but not all, studies. Uncertainty remains regarding the impact of levothyroxine (LT4) therapy on improving health outcomes in pregnant women with SCH. The objective of this study was to assess the potential benefits of LT4 therapy in pregnant women with SCH. Methods: The medical records were reviewed of pregnant women with SCH, defined as an elevated serum thyrotropin (TSH) of >2.5 mIU/L for the 1st trimester or >3 mIU/L for the 2nd and 3rd trimesters, but £10 mIU/L. Pregnant women were divided into two groups depending on whether they received LT4 (group A) or not (group B). Pregnancy loss and other pre-specified adverse outcomes were evaluated during follow-up. Results: There were 82 women in group A and 284 in group B. Group A had a higher body mass index ( p = 0.04) and a higher serum TSH level ( p < 0.0001) compared with group B. Group A had fewer pregnancies lost (n = 5 [6.1%] vs. n = 25 [8.8%]; p = 0.12), low birth weight (LBW) offspring (1.3% vs. 10%; p < 0.001), and no neonates with a five-minute Apgar score £7 (0% vs. 7%; p < 0.001) compared with group B. Other pregnancy-related adverse outcomes were similar between the two groups. Inferences remained unchanged after considering different models to adjust for potential predictors of outcome. Conclusions: LT4 therapy is associated with a decreased risk of LBW and a low Apgar score among women with SCH. This association awaits confirmation in randomized trials before the widespread use of LT4 therapy in pregnant women with SCH.

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“…11 This was due to research which reported multiple maternal and neonatal adverse outcomes associated with subclinical hypothyroidism, however the role of thyroxine therapy in preventing these outcomes was unclear. 21 The American Thyroid Association in 2017 updated its guidelines for the management of thyroid disease in pregnancy following new research. Thyroxine should be given if there are antithyroid antibodies and the initial TSH is 2.5-4 mIU/L.…”

Section: Antithyroid Therapymentioning

confidence: 99%