Abstract
BackgroundHypertensive disorders of pregnancy (HDP) are characterized by hemodynamic disturbances. Altered thyroid function is a risk factor for poor outcomes of pregnancy. However, the associations between thyroid function biomarkers and maternal hemodynamics during pregnancy in HDP remain unclear.MethodsFrom January 2016 to January 2018, pregnant women diagnosed with HDP admitted to the Nanjing Maternity and Child Health Care Hospital were prospectively enrolled in the third trimester. Normally distributed variables were expressed as mean ± standard deviation and skewed variables were expressed as median (25th percentile, 75th percentile). Correlations between thyroid-stimulating hormone (TSH) or free thyroxine (FT4) and maternal hemodynamic parameters were assessed by Pearson’s correlation coefficient and 95% confidence interval (95%CI). Bonferroni’s correction for multiple correlations was performed. Logistic regression models with odd ratio (OR) and 95%CI were applied to confirm the associations.ResultsA total of 163 third-trimester pregnant women with HDP with a mean gestational age of 35.62 ± 2.83 weeks were recruited. The infant birth weight of patients with elevated TSH levels was lower than that of patients with normal TSH levels (2635 ± 867 g vs. 3037 ± 673 g, p = 0.002). Reduced cardiac output (CO) was defined as CO < 3.5 L/min. The infant birth weight of patients with reduced CO was lower than that of patients with normal CO (2250 ± 510 g vs. 2890 ± 774 g, p = 0.002). TSH levels were significantly and negatively correlated with CO (r = − 0.260, 95%CI: − 0.392- -0.103, p < 0.001). FT4 levels were not significantly correlated with any of the maternal hemodynamic parameters (all p > 0.05). TSH level (OR = 1.371, 95%CI: 1.086–1.733, p = 0.008) was confirmed associated with reduced CO in the logistic regression analysis.ConclusionsElevated TSH levels are associated with reduced CO in HDP during the third trimester.
Highlights
Hypertensive disorders of pregnancy (HDP) are characterized by hemodynamic disturbances
Our research demonstrated that patients with elevated thyroid-stimulating hormone (TSH) levels, which may include those with hypothyroidism during pregnancy, had significantly higher rates of low-birth-weight infants
Perinatal outcomes were poorer for both women with higher TSH levels and those with reduced cardiac output (CO), which provides clues regarding the potential linkage between TSH and maternal hemodynamic alterations
Summary
Hypertensive disorders of pregnancy (HDP) are characterized by hemodynamic disturbances. Altered thyroid function is a risk factor for poor outcomes of pregnancy. The associations between thyroid function biomarkers and maternal hemodynamics during pregnancy in HDP remain unclear. Hypertensive disorders of pregnancy (HDP) are common complications during pregnancy, with incidence rates of approximately 2–8% [1, 2], and can negatively affect gestational outcomes [1]. The commonly accepted pathogenesis of HDP is the abnormal reconstruction of the spiral artery and placental ischemia [7]. Inflammatory factors secondary to placental ischemia play a key role in inducing vasoconstriction dysfunction in HDP [5]. Studies have suggested that obesity and thyroid dysfunction are major risk factors for the development of HDP [8, 9]
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