Abstract
BackgroundHypothyroidism in pregnancy is an arena of ongoing research, with international conflicts regarding screening, management, and outcomes. Various studies have described the outcomes depending on geographical and international diagnostic criteria. No study has been conducted in this regard from the region of Pakistan. Therefore, we aim to report the clinical features and maternal outcomes of hypothyroid pregnancies and compare the maternal outcomes between uncontrolled and controlled TSH levels in the preconception as well as the gestational period.MethodsWe conducted a cross-sectional retrospective study on 718 cases in the Aga Khan University Hospital after ethical approval. We collected information on pregnant females who have diagnosed hypothyroidism before conception or during their antenatal period. We noted the maternal characteristics and maternal comorbidities. Laboratory data were recorded for thyroid stimulating hormone levels before conception and during gestation. We recorded maternal outcomes as pregnancy loss (including miscarriage, stillbirth/intrauterine death, medical termination of pregnancy and ectopic pregnancy), gestational hypertension, pre-eclampsia, postpartum hemorrhage, placental abruption, and modalities of delivery. Data analysis was performed on Statistical Package for the Social Sciences version 20.0.ResultsAmong 708 hypothyroid women 638 had live births. Postpartum hemorrhage was the most frequent maternal outcome (38.8%). The emergency cesarean section occurred in 23.4% of cases. We determined TSH levels in 53.2, 56.7, 61.7 and 66.6% of cases in preconception, 1st, 2nd, and 3rd trimester periods. A significant association existed between cesarean section and preconception thyrotropin levels > 2.5 mIU/L, whereas postpartum hemorrhage was significantly associated with thyrotropin levels > 2.5 mIU/L in the preconception and third trimester.ConclusionSuccessful live births in our patients were complicated by maternal postpartum hemorrhage and a frequent number of emergency cesarean section.
Highlights
Hypothyroidism in pregnancy is an arena of ongoing research, with international conflicts regarding screening, management, and outcomes
Similar to the non-pregnant state; overt hypothyroidism in pregnancy is defined as increased serum thyroid stimulating hormone (TSH) and decreased serum free thyroxine (FT4), which ranges in prevalence from 0.3–3% of pregnancies in western world [1,2,3], whereas recent studies from some countries of the Asian subcontinent have reported a higher but variable prevalence of 4.8% to up to 13.13% [4,5,6,7]
Most of the patients were diagnosed before pregnancy with unknown initial severity of hypothyroidism, there were more subclinical cases compared to overt hypothyroidism even in those diagnosed during pregnancy
Summary
Hypothyroidism in pregnancy is an arena of ongoing research, with international conflicts regarding screening, management, and outcomes. Similar to the non-pregnant state; overt hypothyroidism in pregnancy is defined as increased serum thyroid stimulating hormone (TSH) and decreased serum free thyroxine (FT4), which ranges in prevalence from 0.3–3% of pregnancies in western world [1,2,3], whereas recent studies from some countries of the Asian subcontinent have reported a higher but variable prevalence of 4.8% to up to 13.13% [4,5,6,7]. As thyroid hormones have many effects on cardiovascular physiology and blood pressure regulation, there is a higher prevalence of gestational hypertension compared to euthyroid women [13,14,15,16,17]. In 2011, National Nutrition Health Survey was conducted in Pakistan, according to which there is 48% iodine deficiency which has improved over the last decade [30]
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