Abstract
Few data are available evaluating obstetrical outcome when thyroiditis coexist with autoimmune diseases. Objectives of our study were: 1) To assess the prevalence of thyroiditis in pregnant women with autoimmune diseases; 2) To evaluate the effects on pregnancy outcome when different autoimmune diseases are associated with thyroiditis. Two groups of pregnant women were analysed: a study group of pregnant women with autoimmune diseases (n = 268) versus a control group of pregnant women (n = 1,150). In both groups the research for thyroid antibodies, anti-thyroid peroxidase antibodies and anti-thyroglobulin antibodies, was performed. The positivity had a prevalence of 17.54% in women with autoimmune diseases (n = 47) versus 5.57% in the control group (n = 64) (p-value < 0.00001). Only major rheumatic diseases (MRD) were analysed for pregnancy outcome (week of delivery, birth weight and birth weight percentile): systemic lupus erythematosus (SLE) n = 36, antiphospholipid syndrome (APS) n = 44 and connective tissue diseases (CTD) n = 23. MRD were divided according to positive or negative results for thyroid antibodies. Thyroiditis in CDT patients showed a detrimental effect on pregnancy outcome, in terms of earlier week of delivery: 37.86 ± 0.90 (mean ± SD) in CTD with thyroiditis versus 38.56 ± 0.73 (mean ± SD) in CTD without thyroiditis (p-value = 0.03) and lower birth weight: 2,790.71 g ± 257.17 SD in CTD with thyroiditis versus 3,019.33 g ± 305.48 g in CTD without thyroiditis (p-value < 0.05). In SLE and APS thyroiditis did not appear to influence pregnancy outcome. However, we suggest investigating anti-thyroid antibodies in all autoimmune diseases with special attention to pregnant women with thyroiditis and CTD.
Highlights
During pregnancy, the maternal thyroid gland faces several metabolic, hemodynamic, and immunologic changes (Gaberšček and Zaletel, 2011)
The objectives of our study were: 1) To assess the prevalence of autoimmune thyroiditis in pregnant women affected by autoimmune diseases in comparison to that of control pregnant women; 2) To evaluate the effects on pregnancy outcome when different autoimmune diseases are associated with thyroiditis in terms of gestational week at delivery, birth weight and birth weight percentile
antiphospholipid syndrome (APS) showed a rate of 35%, connective tissue diseases (CTD) a rate of 25%, and systemic lupus erythematosus (SLE) had a rate of 24%
Summary
The maternal thyroid gland faces several metabolic, hemodynamic, and immunologic changes (Gaberšček and Zaletel, 2011). The presence of thyroid antibodies against thyroglobulin (anti-TG), thyroid peroxidase (anti-TPO), or thyrotropin receptor autoantigens (anti-TR) are common pregnancy-related diseases. The prevalence of thyroid peroxidase antibodies is increased almost 10-fold in women compared with men, it increases with age, and it has been reported in 2.7–10% of pregnant women (Pop et al, 2003; Casey et al, 2007; Negro et al, 2011; El Baba and Azar, 2012). A useful algorithm was recently proposed by expert opinions for the assessment and management of thyroid diseases in the preconception period or early pregnancy (Anandappa et al, 2020). The screening for thyroid diseases is highly recommended in case of women with autoimmune conditions (Anandappa et al, 2020)
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