Thyroid Dysfunction In Pregnancy Research Articles

HDAC1/2/3-mediated downregulation of neurogranin is involved in cognitive impairment in offspring exposed to maternal subclinical hypothyroidism.

Subclinical hypothyroidism (SCH) in pregnancy is the most common form of thyroid dysfunction in pregnancy, which can affect fetal nervous system development and increase the risk of neurodevelopmental disorders after birth. However, the mechanism of the effect of maternal subclinical hypothyroidism on fetal brain development and behavioral phenotypes is still unclear and requires further study. In this study, we constructed a mouse model of maternal subclinical hypothyroidism by exposing dams to drinking water containing 50 ppm propylthiouracil (PTU) during pregnancy and found that its offspring were accompanied by severe cognitive deficits by behavioral testing. Mechanistically, gestational SCH resulted in the upregulation of protein expression and activity of HDAC1/2/3 in the hippocampus of the offspring. ChIP analysis revealed that H3K9ac on the neurogranin (Ng) promoter was reduced in the hippocampus of the offspring of SCH, with a significant reduction in Ng protein, leading to reduced expression levels of synaptic plasticity markers PSD95 (a membrane-associated protein in the postsynaptic density) and SYN (synaptophysin, a specific marker for presynaptic terminals), and impaired synaptic plasticity. In addition, administration of MS-275 (an HDAC1/2/3-specific inhibitor) to SCH offspring alleviated impaired synaptic plasticity and cognitive dysfunction in offspring. Thus, our study suggests that maternal subclinical hypothyroidism may mediate offspring cognitive dysfunction through the HDAC1/2/3-H3K9ac-Ng pathway. Our study contributes to the understanding of the signaling mechanisms underlying maternal subclinical hypothyroidism-mediated cognitive impairment in the offspring.

Maternal and fetal outcome in COVID 19 positive pregnant women with thyroid dysfunction

Background: Normally functioning thyroid glands are able to meet the increasing need for hormones during pregnancy and keep thyroid hormone levels within normal limits. However thyroid dysfunction in pregnancy can cause adverse maternal and fetal outcomes like pre-eclampsia and gestational hypertension, antepartum hemorrhage, anemia, preterm delivery, low birth weight and addition of SARS-CoV-19 infection can worsen the perinatal outcome. In present ambispective study, obstetric outcomes of 32 cases of COVID 19 positive pregnant women with thyroid dysfunction (Group A) were compared with 32 cases of COVID 19 negative pregnant women with thyroid dysfunction (Group B). Results: Pregnancy induced hypertension (PIH) was the most common antepartum complication noted in both the groups (28.1% vs 12.5%). Group-A had 40.6% LSCS rate whereas it was 37.5% in group-B. Average period of gestation at delivery was 38 weeks in both the groups. The most common neonatal complication was low birth weight (9.4%) in both the groups. Group A was also associated with meconium aspiration syndrome (MAS) (9.4%), neonatal sepsis (6.2%) and transient tachypnoea of newborn (TTN) (3.1%). NICU admissions were 37.5% in group A while only 6.25% in group B. (p value <0.01). Most common indication for NICU admission was MAS (9.4%) in group A. It was observed that incidence of pregnancy induced hypertension (PIH) and neonatal complications including NICU admissions were increased in presence of both COVID 19 and thyroid disorder as compared to only thyroid disorder in pregnancy. Multi-disciplinary approach with more vigilant monitoring can help reduce perinatal morbidity and mortality.

Assessment of iodine nutritional status and gestational thyroid function reference ranges during the first trimester of pregnancy in Taiwan.

Iodine nutrition is critical for fetal neurodevelopment in the first trimester of pregnancy, a period associated with dramatic changes in thyroid function. The aim of this study was to evaluate iodine nutritional status and thyroid function reference ranges in the first trimester in Taiwan. Pregnant women aged 20 years and above in the first trimester were recruited in Taipei Veterans General Hospital, Taiwan from March 2019 to July 2022. Each participant provided a spot urine sample for measurement of urinary iodine concentration (UIC) and a blood sample for checkup of thyroid function and thyroid autoantibodies. A simple food frequency questionnaire was also completed. A total of 209 women with a mean age of 32.9 ± 4.4 years were enrolled. The median UIC was 160.9 μg/L (interquartile range [IQR]: 105.0-246.2 μg/L), indicating overall iodine sufficiency. The gestational thyroid function reference ranges were: thyroid stimulating hormone (TSH) (median: 0.93 [0.007-2.9] µIU/mL), free T4 (1.3 [0.93-2.2] ng/dL), free T3 (3.0 [2.3-5.0] ng/dL), total T4 (9.9 [6.4-16.9] ng/dL), and total T3 (135 [88-231] ng/dL). If the nonpregnant reference range of serum TSH was used, eight women (4.8%) would be misclassified as having subclinical hyperthyroidism, and two women (1.2%) with subclinical hypothyroidism would be missed. In multivariate analysis, nulliparous (adjusted odds ratio [OR] from model 1-3: 2.02, 2.05, 2.02; 95% CI, 1.08-3.77, 1.10-3.81, 1.11-3.66; p = 0.027, 0.023, 0.022, respectively) and multivitamin nonusers (adjusted OR from model 1-3: 1.86, 1.85, 1.78; 95% CI, 1.04-3.34, 1.03-3.32, 1.004-3.71; p = 0.038, 0.039, 0.049, respectively) had increased odds of having lower UIC levels <150 μg/L. The iodine nutritional status in the first trimester is adequate in Taiwan; however, certain subgroups such as nulliparous and multivitamin nonusers are still at risk for iodine deficiency. Gestational thyroid function reference ranges are needed for correct diagnosis of thyroid dysfunction in pregnancy.

Risk Factors for Thyroid Dysfunction in Pregnancy: An Individual Participant Data Meta-Analysis.

Background: International guidelines recommend targeted screening to identify gestational thyroid dysfunction. However, currently used risk factors have questionable discriminative ability. We quantified the risk for thyroid function test abnormalities for a subset of risk factors currently used in international guidelines. Methods: We included prospective cohort studies with data on gestational maternal thyroid function and potential risk factors (maternal age, body mass index [BMI], parity, smoking status, pregnancy through in vitro fertilization, twin pregnancy, gestational age, maternal education, and thyroid peroxidase antibody [TPOAb] or thyroglobulin antibody [TgAb] positivity). Exclusion criteria were pre-existing thyroid disease and use of thyroid interfering medication. We analyzed individual participant data using mixed-effects regression models. Primary outcomes were overt and subclinical hypothyroidism and a treatment indication (defined as overt hypothyroidism, subclinical hypothyroidism with thyrotropin >10 mU/L, or subclinical hypothyroidism with TPOAb positivity). Results: The study population comprised 65,559 participants in 25 cohorts. The screening rate in cohorts using risk factors currently recommended (age >30 years, parity ≥2, BMI ≥40) was 58%, with a detection rate for overt and subclinical hypothyroidism of 59%. The absolute risk for overt or subclinical hypothyroidism varied <2% over the full range of age and BMI and for any parity. Receiver operating characteristic curves, fitted using maternal age, BMI, smoking status, parity, and gestational age at blood sampling as explanatory variables, yielded areas under the curve ranging from 0.58 to 0.63 for the primary outcomes. TPOAbs/TgAbs positivity was associated with overt hypothyroidism (approximate risk for antibody negativity 0.1%, isolated TgAb positivity 2.4%, isolated TPOAb positivity 3.8%, combined antibody positivity 7.0%; p < 0.001), subclinical hypothyroidism (risk for antibody negativity 2.2%, isolated TgAb positivity 8.1%, isolated TPOAb positivity 14.2%, combined antibody positivity 20.0%; p < 0.001) and a treatment indication (risk for antibody negativity 0.2%, isolated TgAb positivity 2.2%, isolated TPOAb positivity 3.0%, and combined antibody positivity 5.1%; p < 0.001). Twin pregnancy was associated with a higher risk of overt hyperthyroidism (5.6% vs. 0.7%; p < 0.001). Conclusions: The risk factors assessed in this study had poor predictive ability for detecting thyroid function test abnormalities, questioning their clinical usability for targeted screening. As expected, TPOAb positivity (used as a benchmark) was a relevant risk factor for (subclinical) hypothyroidism. These results provide insights into different risk factors for gestational thyroid dysfunction.

3 Fluoride Exposure and Hypothyroidism in Pregnant Women: A Potential Mechanism of Fluoride Neurotoxicity

Objective:Fluoride exposure has been associated with thyroid dysfunction, but fluoride's impact on thyroid function in pregnancy is unclear, especially during early gestation when the fetus is dependent on maternal thyroid hormone. We examined the potential thyroid-disrupting effects of maternal fluoride exposure in pregnancy and tested whether thyroid disruption in pregnancy mediates the association between maternal fluoride exposure and child intelligence quotient (IQ) among Canadian mother-child dyads living in areas with optimal fluoridation.Participants and Methods:We measured fluoride concentrations in drinking water and in spot urine samples collected in each trimester from pregnant women enrolled in the Maternal-Infant Research on Environmental Chemicals study. We also measured thyroid hormone (thyroid stimulating hormone [TSH], free thyroxine [FT4], and total thyroxine [TT4]) levels during the first trimester of pregnancy and categorized women as euthyroid (n=1301), subclinical hypothyroid (n=100), or primary hypothyroid (n=28). Those categorized as primary hypothyroid were combined with an additional 79 women who reported clinical diagnoses at time of study enrolment (total n=107). In a sample of 1508 women, we used logistic regression to estimate the association between fluoride exposure and risk of either subclinical or primary hypothyroidism, separately, and linear regression to estimate associations between fluoride exposure and women's thyroid hormone levels (TSH, FT4, TT4). We tested effect modification by child sex and thyroid peroxidase (TPO) antibody status. In a subsample of 439 mother-child pairs, we measured child Full-Scale IQ (FSIQ) at 3-4 years of age using the Wechsler Preschool and Primary Scale of Intelligence. We used linear regression to test associations between maternal hypothyroidism or thyroid hormone levels, and children's FSIQ scores. Finally, mediation analysis in the counterfactual framework was used to estimate the proportion of the effect of maternal fluoride exposure on child FSIQ mediated by maternal hypothyroidism, through evaluation of the natural direct (not through hypothyroidism) and indirect (through hypothyroidism) effects.Results:Using categorical measures of thyroid status, a 0.5 mg/L increase in water fluoride concentration was associated with a 1.64 (95% confidence interval [CI], 1.04 to 2.58) increased odds of primary hypothyroidism. This association was stronger among women with normal TPO antibody levels (&lt; 5.61 IU/mL) (odds ratio, 2.80; 95% CI, 1.24 to 6.36). In contrast, we did not find a significant association between maternal urinary fluoride and hypothyroidism. For continuous measures of thyroid hormone levels, a 1 mg/L increase in maternal urinary fluoride was associated with a 35% (p=0.01) increase in TSH among women pregnant with a female fetus. In our subsample analyses, children born to women with primary hypothyroidism had lower FSIQ than children of euthyroid women, especially among boys (B, 8.78; 95% CI, -16.78 to -0.79). In contrast, maternal TSH, FT4, and TT4 levels were not significantly associated with child FSIQ scores. Maternal primary hypothyroidism did not significantly mediate the relationship between maternal water fluoride concentration and child FSIQ (p natural indirect effect= .35).Conclusions:Fluoride in drinking water may increase the risk of hypothyroidism in pregnancy. Thyroid dysfunction in pregnancy may be one mechanism underlying developmental neurotoxicity of fluoride.

THU348 Thyroid Dysfunction And Diabetes In Pregnancy - Is There A Link?

Abstract Disclosure: R.K. Sahay: Speaker; Self; Novo Nordisk, Roche Diagnostics. S.A. Kalam: None. N. Kudugunti: Speaker; Self; Novo Nordisk. S. Togarla: None. Background: The Indian subcontinent has shown higher prevalence for both thyroid dysfunction and diabetes complicating pregnancy when compared to the Western population. The association between both has been studied in multiple small studies which have however shown discordant results. Hence the need for exploring this further. Aims: To assess the proportion of women with thyroid autoimmunity and thyroid dysfunction in pregnancy complicated by diabetes mellitus and determine association of the same with diabetes in pregnancy and maternal and perinatal outcomes. Methods: 150 pregnant women with gestational/pregestational diabetes were enrolled in this cross sectional study and the proportion of those with thyroid dysfunction were assessed. Thyroid autoimmunity was evaluated in the same population using antiTPO and anti-thyroglobulin antibodies. The proportion of women with thyroid autoimmunity as well as thyroid dysfunction was calculated and the association of these with diabetes in pregnancy was evaluated along with maternal and perinatal outcomes. The same tests were done on 26 pregnant women without diabetes who served as controls. Results: The mean age of the study population was 26.62 ± 4.34 years. 56% were diagnosed with GDM and the rest had pre-GDM. 26.6% of the study population were diagnosed with hypothyroidism. Of these,45% were newly diagnosed during the current pregnancy. The prevalence of antiTPO antibody positivity was found to be 9.33% whereas that of anti-thyroglobulin antibody was 3.33%. Maternal and perinatal complications were higher in the group with combined endocrinopathy with gestational hypertension and preterm delivery showing statistically significant increase among the latter group. Among those women with combined endocrinopathy who developed gestational hypertension,76.9% had GDM. All of them were found to have subclinical hypothyroidism which was newly diagnosed in third trimester. Conclusion: The prevalence of hypothyroidism in pregnancy complicated by diabetes is higher than the prevalence in normal pregnancy. Undiagnosed subclinical hypothyroidism was found to be strongly associated with development of gestational hypertension. Our study emphasises the fact that women with diabetes in pregnancy should receive early and periodic screening for thyroid dysfunction in pregnancy. Presentation: Thursday, June 15, 2023

Prevalence of Hypothyroidism in Pregnancy in a Tertiary Care Hospital

Introduction: Thyroid disorders are the most common endocrine disorders affecting women of reproductive age. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. During early pregnancy, the fetus is totally dependent on maternal thyroid hormone supply. Thyroid hormone is critical for fetal brain and intellectual development. Thyroid hormone is also important for some preventable pregnancy complications like anaemia, low birth weight, abruptio placenta, preeclampsia, etc., which pose special risks for the mother and developing fetus. Aim of the study: To assess the prevalence of hypothyroidism in pregnant women and thus ensure appropriate treatment for the wellbeing of the mother and baby. Methods: This prospective obsessional study was conducted on 113 pregnant women at US Bangla Medical College Hospital, Dhaka, Bangladesh, who attended obstetrics outdoors. Women were randomly chosen irrespective of age, parity, residence, and socioeconomic status. Women with multiple pregnancies or having any pre-existing medical disorder were excluded. All women were investigated for TSH along with routine pregnancy tests. All were divided into two groups: normal/euthyroid and abnormal/thyroid disorders, considering their thyroid status. Result: We found the prevalence of thyroid dysfunction in pregnancy was 17.7%, with hypothyroidism being 15.93%, of which 10.62% were subclinical hypothyroidism, 5.31% were cases of overt hypothyroidism, and 1.77% were cases of hyperthyroidism. Conclusion: This study showed an increased prevalence of hypothyroidism in pregnancy, recommending a need for universal screening for all pregnant women in the early weeks of pregnancy. This study aims at validating the efficacy of the above-mentioned screening for a better pregnancy outcome.

FRI484 Assessment Of Early-trimester Maternal Thyroid Function And Iodine Nutritional Status Of Pregnant Women In Northern Taiwan

Abstract Disclosure: G. Su: None. C. Yeh: None. C. Yang: None. C. Hwu: None. H. Chen: None. F. Wang: None. C. Huang: None. Background: The American Thyroid Association (ATA) has proposed to lower the early-trimester upper limit of the TSH reference interval to become 0.5 mIU/L less than the non-pregnant value. The local-regional reference intervals in Taiwan is unknown. The aim of the study is to evaluate the early-trimester thyroid function and iodine nutritional status of pregnant women in Taiwan. Methods: Women aged ≥20 years-old and in gestation 8 to 15 weeks were recruited in Taipei Veterans General Hospital from March 2019 to July 2022. Thyroid function and antibodies, including TSH, free T4, free T3, total T4, total T3, anti-thyroglobulin antibody (aTG) and anti-thyroidperoxidase antibody (aTPO), TSH receptor antibody, were measured. The gestation-specific thyroid function reference range was derived from the 2.5th and 97.5th percentiles of the studied women. Random spot urine sample was collected and urinary iodine concentration was checked by inductively coupled plasma mass spectrometry. A simple food frequency questionnaire was also completed. Results: A total of 211 women were enrolled and the derived early-trimester upper limit of serum TSH (median: 0.92 [0.007-3.08] uIU/mL) was lower than the value provided by the manufacturer (0.27-4.2 uIU/mL), while the upper limit of free T4 (median: 1.28 [0.93-2.15] ng/dL) and free T3 (3.00 [2.30-5.10]ng/dL) were both higher than the non-pregnant value (0.93-1.7 ng/dL and 2.0-4.4 ng/dL, respectively). The range of total T4 (median: 9.90 [6.39-15.36] ng/dL) and total T3 (median: 136 [89.50-223.20] ng/dL) in the studied women were similar to the non-pregnant range (5.1-14.1 ng/dL and 80-200 ng/dL, respectively). The positivity rate of aTG &amp; aTPO were 8.6%. Two patients with mild Graves’ disease and three patients with subclinical hypothyroidism were incidentally detected and treated. The positive predictive value for detecting thyroid dysfunction using the non-pregnant reference interval was only 15.9% because subclinical hyperthyroidism (18.2%, n=37) would be over-diagnosed and subclinical hypothyroidism (1.0%, n=2) would be under-diagnosed. The overall median UIC was 160.9 μg/L, indicating a sufficient iodine status. Dairy products were the most commonly consumed iodine-containing food type with 71.8% of the pregnant women ingesting dairy products ≥3 days/week. The median intake frequency for seaweed, fish, and seafood were one day per week. Approximately 34.0% of the women took multivitamin every day, but 58.4% of the women never took multivitamin. Conclusion: Our results indicate that the iodine nutritional status in the early trimester of pregnancy is adequate and that the upper limit of serum TSH was approximately 1.12 uIU/mL lower than the upper limit provided by the manufacturer. Gestation-specific thyroid function reference intervals are needed for correct diagnosis of thyroid dysfunction in pregnancy. Presentation: Friday, June 16, 2023

Thyroid Dysfunction in Pregnancy: A Literature Review

Due to structural similarities between HCG and thyroid-stimulating hormone, thyroid stimulation during pregnancy starts in the first trimester (TSH). The volume of thyroid hormone distribution increases along with placental metabolism, maternal thyroxine transport, and estrogen-mediated changes in thyroxine-binding globulin (TBG), all of which cause a 20–40% rise in early pregnancy thyroid hormone demand. Due to the human chorionic gonadotropin alpha subunit's cross-reactivity with the TSH receptor, the reference range of laboratory values for TSH is lower. High serum protein levels may alter estimates rather than direct measurements of free thyroxine (FT4), leading to reported results that are inaccurate. The clinical range of thyroid dysfunction during pregnancy can include both hyperthyroidism (Graves' disease and transitory gestational thyrotoxicosis) and hypothyroidism (overt hypothyroidism, subclinical hypothyroidism, and autoimmune thyroid disease). The risk of preterm and infant respiratory distress syndrome is increased by this malfunction.

Thyroid dysfunction in pregnancy- when not to treat

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Evaluation of Thyroid Function during Pregnancy and Effects of Thyroid Dysfunction on Maternal Outcome: A Prospective Cross Sectional Study in a Tertiary Care Hospital in Northern India

Background: Thyroid disorders are prevalent in women of child-bearing age and for this reason commonly present in pregnancy and the puerperium. Thyroid disease is the second most common endocrine disease to affect women of reproductive age. Uncorrected thyroid dysfunction in pregnancy has adverse effects maternal well-being [1]. In this context, the study was conducted with the objective to evaluate the thyroid function in pregnant females attending antenatal clinic at Post Graduate Department of Obstetrics and Gynaecology, SKIMS, Soura and to study the adverse effects of thyroid dysfunction on maternal health. Methods: This prospective cross sectional study was carried out in pregnant women who attended the antenatal clinic at post graduate department of obstetrics and gynecology, SKIMS from September 2018 for a period of 12 months. The study cases selected were pregnant women at 10 weeks of gestation and their TSH, T3, T4 levels were evaluated as is done here as a routine antenatal work up. Total of 600 patients were taken from the said gestational age and were evaluated for TSH, T3, T4 levels. Well informed consent was taken from all patients. Only those subjects who met the eligibility criteria, as described later were taken for study. After proper scrutiny, 600 patients who were fit to be included in study were selected. For thyroid function test (TFT) 10 ml of blood sample of pregnant women was drawn at 10 weeks in the first trimester. TFT were assessed by quantitative analysis of serum. Depending upon the fasting TSH values they were grouped as group A including patients having TSH &gt; 2.5mIU/L, and patients with TSH &lt; 0.1mIU/Land group B having TSH levels of 0.1mIU/l– 2.5mIU/L. Results: The mean age of the population studied was 25.31+/-4.20 years (mean age +/-SD). The range was from 18 – 38 years. 232 patients (38.6%) were from urban areas and 368 patients (61.38%) were from rural areas. The patients with TSH value of &gt; 2.5mIU/L and &lt; 0.1mIU/L were taken as Group A, and patients with TSH value of 0.1 – 2.5mIU/L were taken as Group B. It was observed that rates of abortion, pre eclampsia, preterm labour, IUGR and placental abruptionwere significantly higher in group A. The rates of GDM, stillbirth, PPH, congenital malformations, however, were comparable between the two groups.

Survey on a Cohort of Subjects Aged From 6 Months to 18 Years and Born to Mothers Managed for Thyroid Hypo-Function in Pregnancy. Experience in a Single Non-Academic Centre in Liguria, Italy

Background: The adequate management of thyroid dysfunction in pregnancy reduces pre-partum adverse events and improves the life of the new-born. Aim: Women managed for thyroid hypo-function during pregnancy were retrospectively identified and a survey was performed on their offspring aged from 6 months to 18 years. Methods: We selected 131 pregnancies for survey. From January to August 2022, the mothers were sent a questionnaire containing questions on the neonatal and post-natal period and questions on their children's current auxological, scholastic and pathological status and lifestyle. Eighty-two questionnaires were returned. The mothers’ replies were compared with their f-T4 and TSH levels recorded during pregnancy. Reference f-T4 and TSH values were extrapolated from 76 pregnancies managed according to current guidelines. Results: f-T4 values below the 2.5th percentile were found in less than 3% of cases, while f-T4 values above the 97.5th percentile were found in less than 4%. TSH proved more variable. Replies regarding the time of the new-born’s first postural changes were significantly inversely correlated with f-T4 concentrations in each trimester of pregnancy and positively correlated with the TSH levels observed in the 1st trimester. Conclusions: This single-centre, cross-sectional, study offers further indications for the management of thyroid hypofunction in pregnancy and suggests that the control of maternal f-T4 and TSH levels during pregnancy has improved in our district. Data from survey indicate that f-T4 influences early motor activity in new-borns more than TSH does. However, the small sample size, the wide age range of the children and the long time-lag between delivery and survey administration could impair our results.

Prevalence and Complications of Subclinical and Overt Hypothyroidism in Pregnancy at North Indian Tertiary Care Center.

Thyroid disorders are one of the commonest endocrine problems among pregnant women. It is often argued that it is not only overt, but subclinical thyroid dysfunction also has similar adverse effects on maternal and fetal outcomes. There is a huge deficiency of data from the Indian population to assess the prevalence of thyroid dysfunction in pregnancy. This study aimed to determine the prevalence of thyroid disorders in pregnancy and their impact on obstetrical outcomes in the Indian population. The study also had the objective of finding a correlation between maternal and fetal thyroid-stimulating hormone (TSH) levels in hypothyroid pregnancies. Around 1055 pregnant women in the first and second trimesters were enrolled in the study. A detailed history was noted and general examinations were done. Apart from routine obstetrical investigations, TSH level estimation was done. If the TSH level was deranged, then free T4 (fT4) and free T3 (fT3) levels were also estimated. Furthermore, 50 hypothyroid and euthyroid pregnant women from the same cohort were followed till delivery. Their obstetrical and perinatal outcomes were noted. The prevalence of thyroid dysfunction was 36.5% in this study, which was quite high in the population. Moreover, hypothyroid groups were prone to have pregnancy-induced hypertension (P = 0.03), intrauterine growth restriction (P = 0.05), and preterm delivery (P = 0.04) as compared to control. Cesarean section rate for fetal distress was significantly higher among pregnant hypothyroid women (P = 0.05). Neonatal respiratory distress and low appearance, pulse, grimace, activity, and respiration (APGAR) () scores were significantly more in the hyperthyroidism group (P = 0.04 and P = 0.02, respectively). Maternal TSH was significantly correlated with hemoglobin levels, HbA1c, and systolic blood pressure. Significant adverse effects on maternal and fetal outcomes were seen emphasizing the importance of routine antenatal thyroid screening.

Thyroid dysfunction in pregnancy - a retrospective observational analysis of a Maltese cohort

BackgroundThyroid dysfunction is known to adversely affect pregnancy. This studyevaluates the prevalence of thyroid disorders and explores their associationwith pregnancy complications/comorbidities and modes of delivery in the Maltesepregnant population over a ten year period.DesignA population based observational study.MethodWe analysed data from the National Obstetrics Information Service of theDepartment of Health Informations and Research (NOIS) for all births deliveredin Malta between 2006 and 2016. Cases identified and recorded by NOIS to have had some form of thyroiddysfunction during pregnancy were confirmed by cross-referencing with laboratory results found in patients’medical records and/or iSOFT® database system. Using the Statistical Packagefor the Social sciences (SPSS®) demographic data, pastobstetric and medical history and obstetric outcomes were analysed forpregnancies with thyroid dysfunction and compared to data pertaining to pregnancies in euthyroid patients, that is those with no recorded thyroid dysfunction on NOIS. Chi square/Fisher'sexact test were used to compare categorical variables while ANOVA/Mann-WhitneyU test was used to compare continuous variables. Statistical significance wasdefined by a two-sided p value <0.05.ResultsData was available for 46,283 women (mean [SD] age = 29.2 [5.4] years).587 pregnancies (1.3%) suffered from thyroid dysfunction. Of these, 67.3% werehypothyroid, 3.2% had hyperthyroidism, 28.3% had isolated hypothyroxinaemia(IHT) while 1.2% had a history of thyroid carcinoma. Patients with IHT andhypothyroidism were older than euthyroid patients (p < 0.001). IHT and hypothyroid patients had astatistically significant higher body mass index (BMI) than euthyroid women(p=0.001 for hypothyroid women, p = 0.035 for IHT). Hypothyroid and IHT women were more likely to have had aprevious lower segment caesarean section (p=0.043, and 0.006respectively). Type 1 diabetes and gestational diabetes p = 0.012) were more common associatedcomorbidities in hypothyroid pregnancies. Offspring of patients with IHT had ahigher birth weight than those born to euthyroid patients (p=0.009). Patients with hyperthyroidism were found to havea significantly increased risk of early preterm delivery before 34 weeks ofgestation and were also more likely to have suspected intrauterine growthrestriction and low mean birth weight. We report no significantdifferences in past history of obstetric loss, antenatal complications, mode ofdelivery, gestational age at delivery and postpartum haemorrhage rates acrossthyroid categories.ConclusionsAvailable evidence suggests that thyroid dysfunction is more likely in thesetting of older age, and higher body mass index. Moreover, it impacts on neonatalbirth weight, rates of early preterm delivery and intrauterine growthrestriction.

Prevalence of thyroid dysfunction in pregnancy and its association with feto-maternal outcomes: A prospective observational study from a tertiary care institute in Northern India

BackgroundThyroid dysfunction in pregnancy is one of the most prominent endocrinological disorders. Physiological changes in thyroid status and non-adaptation to these changes during pregnancy lead to thyroid dysfunction resulting in feto-maternal complications. In this context, we undertook this study to estimate the prevalence of thyroid disorders in pregnant women and their association with feto-maternal outcomes. MethodsThis prospective observational study was carried out in a tertiary care institute in Punjab, North India. We recruited 347 pregnant women who visited the OPD (Out Patient Department) through consecutive sampling, out of which 300 were included in our final analysis. A detailed history and clinical examination were made. Apart from routine ante-natal investigations, we estimated the TSH levels. In case of abnormal TSH values, free T4 and T3 levels were assessed. Study participants were followed till 12 weeks post-delivery to observe their obstetrical and perinatal outcomes. ResultsOverall prevalence of thyroid disorders in pregnancy was 33.9%, with hypothyroidism (31.6%) being more common than hyperthyroidism (2.3%). A significant association was found between thyroid disorders and feto-maternal complications (p value < 0.001). Adverse maternal effects observed in the hypothyroid group as compared to the euthyroid group were preeclampsia (14.7% vs. 5.6%), anemia (7.4% vs. 6.1%), abortion (7.4% vs. 0.5%) and meconium-stained liquor (5.3% vs. 2.5%). Abortion (71.4%) was the main complication in the hyperthyroid group. Adverse neonatal outcomes were low and very low birth weight, low Apgar scores, respiratory distress syndrome, and meconium aspiration syndrome. ConclusionWe observed a high prevalence of thyroid disorders and their relative adverse effects. Universal screening of all women in the pre-conception period or as early as pregnancy is diagnosed, is recommended to reduce subsequent feto-maternal morbidity and mortality.

Pregnancy Related Thyroidal Dysfunction and its Feto-Maternal Outcomes

Aim: To detect the thyroidal dysfunction during pregnancy and the related outcomes. Study Design: Prospective study. Place and duration of study: Department of Obstetrics &amp; Gynaecology, S. Z. Hospital Lahore from 01-01-2021 to 30-06-2022 Methodology: One thousand pregnant women in third trimester were enrolled for thyroid function test and screening, analysis of TSH, free T3 and T4 level. Results: Only 30 (3%) was having thyroid dysfunction while the dysfunction was reported highest in the women within 29-38 years of age. Most of the cases suffering from thyroid dysfunction are suffering from the subclinical hypothyroid condition (43%). The reduction in Apgar score was observed up to almost 3.59 times in newborns of thyroid dysfunction women. The risk of preeclampsia and cesarean section was also significantly raised in thyroidal dysfunction women. Odds ratio for low birth weight was observed as 6.32 with a significant association with thyroid dysfunction in pregnancy. Conclusion: There are poor feto-maternal outcomes of thyroid dysfunction during pregnancy with 43% of the cases as having subclinical hypothyroidism. Key words: Pregnancy, Thyroid dysfunction, Feto-maternal outcome

Thyroid Dysfunction in Pregnancy and its Outcome

Objective: To identify the thyroid dysfunction in pregnancy and its outcomes. Study Design: Prospective study Place and Duration of Study: Department of Obstetrics &amp; Gynaecology, Sheikh Khalifa Bin Zayed Al-Nahyan Hospital/CMH Muzaffarabad Azad Kashmir from 1st October 2021 to 31st March 2022. Methodology: Seventeen hundred pregnant women in third trimester were screened. Out of them, 50 were identified to be suffering from thyroid dysfunction. The pregnant women in their third trimester and within the age group of 18-40 years were recruited. By using enzyme linked sorbent assay the serum levels of TSH, Free T3 and Free T4 were determined for each woman as a routine clinical health check-up practice. The women who had raised analytical levels as well as correlated clinical history were identified as suffering from thyroid dysfunction. These women were further followed for the outcomes of their pregnancy. Results: The prevalence of thyroid dysfunction was 2.9%. There were 42% pregnant women suffering from subclinical hypothyroidism while 36% were having overt hypothyroidism and 12% had subclinical hyperthyroidism. Conclusion: The major outcome of thyroid dysfunction in pregnancy in terms of maternal and fetal outcomes was presence of anemia in women and was 4.89%. In women considering fetal outcomes, low birth weight was observed in 32% neonates with a need of neonatal intensive care for 42% of newborns were seen. Keywords: Thyroid dysfunction, Pregnancy, Outcome

Late offspring effects of antenatal thyroid screening.

Thyroid dysfunction in pregnancy is associated with adverse offspring outcomes and recent birth-cohort studies suggest that even mild degrees of thyroid dysfunction may be linked with a range of late cognitive and behavioural effects in childhood and adolescence. This review summarizes recent literature of observational studies and critically appraises randomized controlled trials (RCTs) of antenatal thyroid screening and Levothyroxine intervention. Overt hypothyroidism and hyperthyroidism carry significant risks for unfavourable offspring outcomes and should be appropriately corrected in pregnancy. The significance of subclinical hypothyroidism and hypothyroxinaemia is still unclear. Meta-analyses of birth-cohort studies show associations of maternal subclinical hypothyroidism and hypothyroxinaemia with intellectual deficits, attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders, while hyperthyroidism and high-normal FT4 were linked with ADHD. RCTs have shown no benefits of screening on neurodevelopmental outcomes although Levothyroxine could have been initiated too late in pregnancy in these trials. A small number of studies have shown inconsistent associations of maternal thyroid dysfunction with offspring cardiometabolic indices including blood pressure and body weight. Correction of maternal thyroid dysfunction was, however, associated with favourable long-term metabolic profiles in mothers, including lipid profiles, fat mass and body mass index. Antenatal thyroid screening may therefore present opportunities for optimizing a wider range of outcomes than envisaged. Future trials with early antenatal thyroid screening and intervention are necessary to clarify the impact of screening on late offspring and maternal effects.

Development of a laboratory alerting system for the early diagnosis of thyroid dysfunction in pregnancy

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Thyroid Dysfunction in Pregnancy and its Outcomes

Aim: To evaluate thyroid dysfunction in pregnancy and its outcomes. Study design: Descriptive study Place and duration of study: Department of Obstetrics &amp; Gynaecology, Unit IV, Liaquat University of Medical &amp; Health Sciences, Jamshoro from 1st January 2021 to 31st December 2021. Methodology: Two hundred females between 18-41 years were registered in the outdoor patient in their 10th week of pregnancy. A 2cc blood was withdrawn, serum separated and stored at -20ºC until analysis. Results: The mean age was 26.9±2.6 years. The women who were having hypothyroidism or hyperthyroidism had various complications during their pregnancy with 100% of them presenting depression and fatigue. There were 6.6% pregnant women suffering from hypo or hyperthyroidism who suffered miscarriages. Conclusion: Hypothyroidism/hyperthyroidism is prevalent in South Asian women and related with pregnancy complication and negative pregnancy outcomes in females. Keywords: Thyroid dysfunction, Pregnancy, Outcome