Abstract
ProblemThe effect of thyroid autoimmunity (TAI) on the prevalence of recurrent miscarriage (RM) is highly debatable. No meta‐analysis has been published in the past decade to investigate the impact of TAI on women with RM.Method of StudySystemic literature search was conducted on PubMed, Embase, Cochrane, and Web of Science databases. English language literatures published between 1993 and 2019 were selected. We assessed the relationship between the prevalence of RM and thyroid peroxidase antibodies (TPO‐Ab) or antithyroid antibodies (ATA) and evaluated the thyroid‐stimulating hormone (TSH) level in TPO‐Ab‐positive women with RM. We also observed the treatment effect with levothyroxine (LT4) for RM. Review Manager 5.3 software was used to obtain the pooled odds ratios (OR).ResultsAnalysis of 22 eligible studies revealed significant association between TPO‐Ab and the prevalence of RM (OR = 1.85; 95% CI, 1.38 to 2.49; P < .001)(n ≥ 3), (OR = 1.82; 95% CI, 1.13 to 2.92; P = .01) (n ≥ 3). Women with ATA + had higher risk of RM (OR = 2.36; 95% CI, 1.71 to 3.25; P < .00001)(n ≥ 3), (OR = 2.34; 95% CI, 1.70 to 3.22; P < .00001)(n ≥ 2). RM women with TPO‐Ab had higher TSH level when compared with those negative for TPO‐Ab (random‐effect SMD = 0.60; 95% CI, 0.31 to 0.90; P < .0001). We also found beneficial effects of LT4 supplementation on the outcome of live birth rate (LBR) among pregnant women with TPO‐Ab (OR = 3.04; 95% CI, 0.69 to 13.36; P = .14).ConclusionThe presence of serum antithyroid antibodies does harms to women and can even lead to recurrent miscarriage; LT4 treatment may have beneficial to RM women.
Highlights
Thyroid disease is one of the most frequent endocrine conditions in women of childbearing age.[1]
Thyroid autoimmunity has been found to be related to subclinical hypothyroidism (SCH),[6] which is defined as high levels of serum thyroid-stimulating hormone (TSH) despite normal levels of serum free thyroxine (FT4).[7]
We propose that TSH levels of thyroid autoimmunity (TAI) women are monitored stringently for women with recurrent miscarriage (RM) before pregnancy and further large scale prospective, randomized, placebo controlled trials are carried out to evaluate the effect of treatment for antithyroid antibodies in euthyroid women with RM
Summary
Thyroid disease is one of the most frequent endocrine conditions in women of childbearing age.[1]. TAI is defined as the presence of antithyroid antibodies (ATA), thyroid peroxidase antibodies (TPO-Ab) and/or thyroglobulin antibodies (Tg-Ab).[3]. With a prevalence of 5%-20%, TAI is the most common autoimmune condition in women of reproductive age.[4]. Thyroid autoimmunity has been found to be related to subclinical hypothyroidism (SCH),[6] which is defined as high levels of serum thyroid-stimulating hormone (TSH) despite normal levels of serum free thyroxine (FT4).[7]. Both thyroid dysfunction and thyroid autoimmunity are known to cause adverse pregnancy outcomes during all trimesters of pregnancy.[8]. The presence of ATA, TPO-Ab, has been associated with miscarriage, preterm birth, and post-partum thyroid disease.[9-11]
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