Thyroid Dysfunction in Pregnancy. Fetal Loss and Follow-Up Evaluation of Surviving Infants

Greenman, George W.; Gabrielson, Mary O.; Howard-Flanders, June; Wessel, Morris A.

doi:10.1097/00006254-196318010-00018

Cited by 14 publications

(18 citation statements)

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“…The incidence is as high as 5% if one includes anomalies detected later in childhood, including mental retardation [27]. It is also consistent with most previous reports not associating PTU exposure during pregnancy with a teratogenic risk in humans [10][11][12][13][14][15][16][17][18].This study has confirmed that PTU does not represent a major teratogenic risk when used in clinically recommended doses in humans.…”

Section: Discussionsupporting

confidence: 90%

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Pregnancy outcome, thyroid dysfunction and fetal goitre after in utero exposure to propylthiouracil: a controlled cohort study

Rosenfeld

Ornoy

Shechtman

et al. 2009

Brit J Clinical Pharma

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Section: Discussionsupporting

confidence: 90%

“…In human studies, the prevalence of congenital anomalies after in utero exposure to PTU is well within the expected rate of anomalies [11,12]. However, only few studies have been published and their sample size was relatively small (n < 50) [12][13][14][15][16][17][18][19][20]. Moreover, no recent studies have been published.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcome, thyroid dysfunction and fetal goitre after in utero exposure to propylthiouracil: a controlled cohort study

Rosenfeld

Ornoy

Shechtman

et al. 2009

Brit J Clinical Pharma

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“…1 7 Neither of these earlier studies linked TSH measurements with pregnancy complications or outcome in the entire cohort. Other studies suggested that adverse events such as fetal death, premature birth, low birthweight, placental abruption, and pregnancy induced hypertension [8][9][10][11] occur more often in women with clinically diagnosed hypothyroidism. These observations, however, have been limited to women attending high risk or specialty clinics and may not reflect findings in the general population.…”

Section: Discussionmentioning

confidence: 99%

Maternal thyroid deficiency and pregnancy complications: implications for population screening

et al. 2000

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Objective-To examine the relation between certain pregnancy complications and thyroid stimulating hormone (TSH) measurements in a cohort of pregnant women. Methods-TSH was measured in sera obtained from women during the second trimester as part of routine prenatal care. Information was then collected about vaginal bleeding, premature delivery, low birthweight, abruptio placentae, pregnancy induced hypertension, need for cesarean section, low Apgar scores, and fetal and neonatal death. Results-Among 9403 women with singleton pregnancies, TSH measurements were 6 mU/l or greater in 209 (2.2%). The rate of fetal death was significantly higher in those pregnancies (3.8%) than in the women with TSH less than 6 mU/l (0.9%, odds ratio 4.4, 95% confidence interval 1.9-9.5). Other pregnancy complications did not occur more frequently Conclusion-From the second trimester onward, the major adverse obstetrical outcome associated with raised TSH in the general population is an increased rate of fetal death. If thyroid replacement treatment avoided this problem this would be another reason to consider population screening. (J Med Screen 2000;7:127-130) Keywords: thyroid stimulating hormone; pregnancy; fetal death Although clinically apparent maternal hypothyroidism during pregnancy has long been known to be associated with both maternal and fetal complications, most of the studies documenting those problems have focused on patients in specialty or high risk clinics. The present study assesses the impact of maternal hypothyroidism in a cohort of pregnant women being managed in primary care settings. In 1991, our group reported thyroid stimulating hormone (TSH) measurements in a cohort of 2000 pregnant women whose sera were being obtained for -fetoprotein measurements at 15-18 weeks' gestation as part of routine care. 1 TSH measurements were at, or above, 6 mU/l in 49 of the women (2.4%). In six of these 49 women the thyroxine (T 4 ) and/or free T 4 measurements were suYciently abnormal (more than two standard deviations below the average) for clinical manifestations to be anticipated. It was not possible to gather individual information about health status in this cohort, because all identifiers were removed from the serum samples before the thyroid measurements were performed. Given the frequency of thyroid deficiency identified in this pregnancy population, it was decided that its possible impact on late pregnancy and delivery should be evaluated. To accomplish this, it was necessary to study a second, larger cohort of pregnant women. Materials and methodsThe Foundation for Blood Research oVers prenatal serum screening services for open neural tube defects and Down's syndrome to all primary care prenatal practices in Maine. The testing is generally performed between 15 and 18 weeks' gestation. Approximately two thirds of the women receiving prenatal care in Maine opt for those services.Between July 1990 and June 1992 the order form for the prenatal screening test contained a supplementary consent form, asking women...

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“…Women with hypothyroidism who become pregnant carry an increased risk for obstetrical complications such as intrauterine fetal death, gestational hypertension, placental abruption, and poor perinatal outcome [12][13][14][15]. Until now we have diagnosed hypothyroidism during pregnancy by means of low levels of free T 3 and T 4 and high levels of TSH and positive thyroid antibodies, using the reference range established for nonpregnant subjects.…”

Section: Discussionmentioning

confidence: 99%

Maternal Thyroid Function during Pregnancy and Puerperal Period

2005

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Abstract. It has been noted that hypothyroidism in pregnant women can adversely affect the children's subsequent psychoneurotic development. Also, transient elevation of serum free thyroxine is occasionally seen in the first trimester of normal pregnancy. However, normal thyroid function during pregnancy and the puerperal period has not been clearly defined in Japan. The aim of this study was to assess maternal thyroid function during pregnancy and puerperal period in Japan. The concentrations of thyroid stimulating hormone (TSH), free triiodo-thyronine (free T 3 ), free thyroxine (free T 4 ) and thyroid binding capacity (TBC) of 522 normal pregnant and puerperal women (119 in the first trimester; 132 in the second trimester; 135 in the third trimester and 136 in the early puerperium) were measured by electrochemiluminescence immunoassay. We compared the measured data with those of healthy nonpregnant control. Twenty-six (21.8%) of 119 women in the first trimester had lower TSH levels and 23 (16.9%) of 136 women in the early puerperium had higher TSH levels than the normal range of healthy nonpregnant controls. Free T 3 gradually decreased during pregnancy, although it remained within the normal control range. Eight (6.7%) of 119 women in the first trimester had high free T 4 levels, which gradually decreased during pregnancy. Sixty (44.4%) of 135 women in the third trimester had low free T 4 levels. The values of TBC in the second trimester increased compared with the first trimester and did not change in the third trimester and decreased after delivery. There were no correlations between maternal TSH and levels of thyroid hormones (free T 3 or free T 4 ), except for TSH and free T 4 in the first trimester. In conclusion, we showed that maternal thyroid function, especially TSH and free T 4 , changed during the course of pregnancy. In assessing the thyroid function associated with pregnancy, one needs to keep in mind the tendency toward low free T 4 levels in the third trimester and high TSH levels in the early puerperal period.

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Thyroid Dysfunction in Pregnancy. Fetal Loss and Follow-Up Evaluation of Surviving Infants

Cited by 14 publications

References 0 publications

Pregnancy outcome, thyroid dysfunction and fetal goitre after in utero exposure to propylthiouracil: a controlled cohort study

Pregnancy outcome, thyroid dysfunction and fetal goitre after in utero exposure to propylthiouracil: a controlled cohort study

Maternal thyroid deficiency and pregnancy complications: implications for population screening

Maternal Thyroid Function during Pregnancy and Puerperal Period

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