Abstract
Thyroid disorders are among the common endocrine problems in pregnant women. It is now well established that not only overt but subclinical thyroid dysfunction also has adverse effects on maternal and fetal outcome. There are few data from Bangladesh about the prevalence of thyroid dysfunction in pregnancy. With this background, this study aims to find out thyroid dysfunction (both overt and subclinical hypothyroidism) in pregnancy and its impact on obstetrical outcome. We studied the evaluation of 50 admitted pregnancies corresponding to 29 women with subclinical hypothyroidism and rest 21 was overt hypothyroidism. Detailed history and examination were performed. Apart from routine obstetrical investigations, Thyroid Stimulating Hormone (TSH) estimation was done. Their obstetrical and perinatal outcomes were noted. Overt hypothyroidism was significantly (p < 0.05) higher in 25 to 44 years age group. However two and three abortions were significantly (p < 0.05) higher in overt hypothyroidism patients. In sub clinical hypothyroidism 86.2% conceived firstly within 2 years and 66.7% in overt hypothyroidism patients conceived firstly in between 3 to 5 years after marriage. Overt hypothyroids were prone to have pregnancy-induced hypertension 42.9%, intrauterine growth restriction (P = 0.001) and gestational diabetes (38.1%) as compared to subclinical cases. Neonatal complications were significantly more in overt hypothyroidism group. Mean TSH level was significantly (p < 0.05) higher in overt hypothyroidism patients but mean FT4 level was almost similar in both groups. Majority of the patient underwent caesarean section in both groups due to associated medical and obstetrical complications. None of the babies showed hypothyroidism by cord blood tests. In this analysis our results showed that overt hypothyroidism among Bangladeshi pregnant women are associated with more maternal complication & adverse parental outcome than subclinical hypothyroidism. The adequate treatment of hypothyroidism during gestation minimizes risks and generally, makes it possible for pregnancies to be carried to term without complications. Significant adverse effects on maternal and fetal outcome were seen emphasizing the importance of routine antenatal thyroid screening.
Highlights
Thyroid gland disease is most common endocrine disease in Bangladesh.[1]
We followed 50 pregnancies corresponding to 29 women with subclinical hypothyroidism and 21 with overt hypothyroidism at the time of diagnosis
Maternal age was high in pregnant women with overt hypothyroidism
Summary
Thyroid gland disease is most common endocrine disease in Bangladesh.[1] Thyroid disorders constitute one of the most common endocrine disorders seen in pregnancy. Overt hypothyroid disorder was found in 1.3 per 1,000 and subclinical disease in 23 per 1,000.1 Some studies[2] reported prevalence of overt hypothyroidism between 1 and 2% and subclinical hypothyroidism in 8% of women. Women with hypothyroidism have relatively increased infertility, miscarriage rates and carry an increased risk for obstetric and fetal complications.[3] The main obstetric complications are anemia, preeclampsia, placental abruption and postpartum hemorrhage. Low-birth weight (LBW), fetal distress in labor, fetal death and perinatal death.[4]
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