Abstract
BackgroundPregnancy is a stress test of maternal thyroid function. The prevalence of thyroid dysfunction in pregnant women is high. Subclinical hypothyroidism occurs in 10% of all pregnancies. Effects of hypothyroidism in pregnancy are anemia, low birth weight and mental retardation in neonate. This study is aimed to evaluate maternal and fetal outcomes in pregnant women with deranged thyroid profile. The relevance of this study is to document the association of hypothyroidism and its adverse effects on mother and fetus.MethodsThis prospective observational study was carried out at R.D. Gardi Medical College, Ujjain, India. Subjects of this study were 198 antenatal women in third trimester with singleton pregnancy admitted in the obstetric ward, and informed consent was obtained. Women were chosen irrespective of age, parity, residence and socioeconomic status. Women with multiple pregnancy, a known case of thyroid disorder, or any pre-existing medical disorder were excluded. Routine hematological parameters and estimation of T3, T4 and TSH was conducted. Patients with deranged thyroid profile were subsequently assessed for maternal and fetal complications. History of infertility, family history of thyroid disease, menstrual pattern, recurrent abortion, hemoglobin level and fetal outcome were the main study variables. Data was analysed in SPSS software for statistical co-relation.ResultsPrevalence of thyroid disorder is 11%; with subclinical hypothyroidism, overt hypothyroidism and subclinical hyperthyroidism occurring in 5.6, 3.5 and 1.5% of subjects respectively. In women with subclinical and overt hypothyroidism, anemia was present in 26.3% being significantly associated with hypothyroidism (p = 0.008). With respect to fetal outcome, LBW 31.6% (p = 0.001), NICU admission 42.1%, (p = 0.000) and low APGAR Score (21.1%, p = 0.042) were statistically associated with hypothyroidism. Risk of anemia, Low Birth weight, NICU admissions, and low APGAR score was 4.8, 6.3, 0.14 and 3.64 times higher respectively in women with hypothyroidism than in women who are euthyroid.ConclusionPrevalence of subclinical hypothyroidism is 5.6% in 3rd trimester of pregnancy. Anemia, pre-eclampsia, high caesarean rates and neonatal morbidities is significantly associated with hypothyroidism.
Highlights
Pregnancy is a stress test of maternal thyroid function
Reference ranges of thyroid-stimulating hormone (TSH) or free thyroxine obtained from non-pregnant populations change in pregnant women because of the physiological changes in thyroid function in pregnancy
In light of the high prevalence of thyroid disturbances in pregnancy and associated risk to mother and fetus, this study aims to determine the prevalence of thyroid disorders in pregnancy and its maternal and fetal outcomes in a tertiary care facility in Central India
Summary
Pregnancy is a stress test of maternal thyroid function. Stress of pregnancy may result in clinical or sub clinical hypothyroidism in women with limited reserve. Reference ranges of TSH or free thyroxine (fT4) obtained from non-pregnant populations change in pregnant women because of the physiological changes in thyroid function in pregnancy. Physiological and hormonal changes in pregnancy result in increased production of thyroxin (T4) and triiodothyronine (T3) by up to 50%, leading to an increase in a woman’s daily iodide requirement, while thyroid-stimulating hormone (TSH) levels decrease, especially in the first trimester [1]. In women with low thyroid reserves stress of pregnancy manifests as overt disease [2]. Since hypothyroidism is treated, timely detection and treatment of the dysfunction could reduce the burden of adverse fetal and maternal outcomes in pregnancy which are commonly encountered. Prevalence of overt thyroid dysfunction is 2–3% in pregnant women, subclinical dysfunction is 10%, while rate of autoimmunity is 5–10% [4, 5]
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