Abstract
Background: Pregnancy and parturition reflect the complex interaction between physiological conditions of the mother and her offspring, and fetal health characteristics may affect maternal health throughout pregnancy and delivery. We aimed to investigate the characteristics of the mother-infant dyad of term infants detected as having congenital hypothyroidism (CH). Methods: A retrospective cohort study of 108,717 term infants delivered liveborn at Lis Maternity and Women's Hospital between 2010 and 2017. Infants were detected by the National Newborn Screening Program as having CH (131, 0.12%). Three years of surveillance in the Pediatric Endocrine Clinic revealed that 65 infants had transient CH and 66 had permanent CH. Data on maternal, pregnancy, delivery, and perinatal characteristics of the mother-infant dyads were retrieved from the hospital's electronic database. Results: Mode of delivery differed: a higher proportion of deliveries of CH infants required vacuum assistance, and more infants with CH were born through a cesarean section compared with the general population (p < 0.001). Medication during labor also differed, with higher rates of oxytocin (p < 0.001) and antibiotics (p = 0.008) administered to mothers of CH infants. A multivariate logistic regression model revealed an increased demand for oxytocin administration during the labor of a CH infant in a hypothyroidism severity-dependent manner, expressed as a threefold risk associated with permanent but not transient CH. Conclusions: Our findings of increased utilization of medical interventions during the labor and delivery of CH infants suggest that the prenatal fetal thyroid function may affect the development and progress of labor and delivery, in response to oxytocin.
Highlights
Pregnancy and parturition reflect the complex interaction between the state of health of the mother and her offspring
The aim of this study was to analyze the characteristics of the mother-infant dyad of congenital hypothyroidism (CH) infants in order to identify contributing and non-contributing factors
The analyses revealed increased utilization of medical intervention during the labor and delivery of the infants with any CH
Summary
Pregnancy and parturition reflect the complex interaction between the state of health of the mother and her offspring. There is evidence that fetal health characteristics may affect maternal health outcomes throughout pregnancy and delivery[3]. A better understanding of the bidirectional nature of health characteristics may assist in creating an integrated obstetric medical approach which will take into consideration the mother-infant dyad rather than separate mother and infant. Neonatal thyroid screening aims to detect infants with congenital hypothyroidism (CH) in order to initiate thyroid hormone replacement therapy as soon as possible and prevent mental retardation[4]. The screen detects infants with anatomic (agenesis or ectopic dysgenesis) or genetic thyroid disorders leading to permanent CH, as well as infants with transient abnormal thyroid function who do not require lifelong thyroid replacement therapy[5, 6]. In transient CH, the appropriate maturation of the hypothalamic-pituitary-thyroidal axis may be interrupted by maternal, perinatal, or neonatal factors[7]
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