DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20220165
Published: 2022-01-28

Prevalence of thyroid disorders in antenatal patients and its feto-maternal outcome

Bhavesh B. Airao, Nisi N. Patel, Avni B. Dholariya

Abstract


Background: Thyroid disorders are common in pregnancy and most common disorder is subclinical hypothyroidism. Due to the complex hormonal changes during pregnancy, it is important to remember that thyroxine requirements are higher in pregnancy. Maternal hypothyroidism is an easily treatable condition that has been associated with increased risk of low birth weight, fetal distress and impaired neuropsychological development. Hyperthyroidism in pregnancy is less common as conception is a problem. Majority of them are due to Graves’ disease, though gestational hyperthyroidism is to be excluded. Early and effective treatment of thyroid disorder ensures a safe pregnancy with minimal maternal and neonatal complications.

Methods: One hundred pregnant women attending antenatal clinic in first trimester were registered. Apart from routine basic and obstetrical investigations, TSH, FT3 and FT4 level estimation was done. L-thyroxine was given for hypothyroidism, this dosing was based on a study by Abalovich et al according to the body weight to maintain serum TSH near normal. For hyperthyroidism, given carbimazole if serum TSH level <1 MIU/l. Serum TSH estimation was repeated at regular interval. All the patients followed till the end of pregnancy. The normal patients served as controls. Pregnancy outcome studied statistically.

Results: Around 68.8% of the inadequately treated patients developed complications like GDM, pre-eclampsia, oligohydramnios and preterm deliveries. Whereas only 32% of the control group developed these mentioned complications, this implied a significant association between inadequately treated thyroid disorders and poor pregnancy outcomes as evidenced by the p value of 0.002 which was very significant.

Conclusions: Adequate treatment of thyroid disorders in pregnancy significantly reduces complications like miscarriages, pre-eclampsia, IUGR, oligohydramnios, glucose intolerance, preterm labour, low birth weight babies, abruptio placentae and stillbirth.


Keywords


Thyroid disorders, Pregnancy, Hypothyroidism, Hyperthyroidism

Full Text:

PDF

References


Braverman LE. Adequate iodine intake-the good far outweighs the bad. Eur J Endocrinol. 1998;139(1):14-5.

Glinoer D, DeNayer P, Bourdoux P, Lemone M, Robyn C, Steirteghem AV, et al. Regulation of maternal thyroid during pregnancy. J Clin Endocrinol Metab. 1990;71(2):276-87.

Haddow JE, Palomake GE, Allan WC, Williams JR, Knight GJ, Gagnon J, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. NEJM. 1999;341(8):549-55.

Pop VJ, Kuijpens JL, Baar ALV, Verkerk G, Son MMV, Vijlder JJD, et al. Low maternal free thyroxine concentrations during early pregnancy are associated with impaired psychomotor development in infancy. Clin Endocrinol. 1999;50(2):147-8.

Jones WS, Man EB. Thyroid function in human pregnancy.Premature deliveries and reproductive failures of pregnant women with low serum butanol-extractable iodines. Maternal serum TBG and TBPA capacities. Am J Obstet Gynecol. 1969;104(6):909-14.

Green WL. New questions regarding bioequivalence of levothyroxine preparations: a clinician’s response. AAPS J. 2005;7(1):54-8.

Soldin OP. Thyroid function tests and pregnancy: what’s normal? Ther Drug Monit. 2006;28(1):8-11.

Montoro MM, Collea JV, Frasier,SD, Mestman JH. Successful outcome of pregnancy in women with hypothyroidism. Ann Intern Med. 1981;94(1);31-4.

Cecconi S, Rucii N, Scadaferri ML, Masciulli MP, Rossi G, Moretti C, et al. Thyroid hormones effects on mouse oocyte maturation and granulose cell aromatase activity. Endocrinology. 1999;140(4):1783-8.

Abalovich M, Gutierrez S, Alcaraz G, Maccallini G, Garcia A. Levalle Qovert and subclinical hypothyroidism complicating pregnancy. Thyroid. 2002;12(l):63-8.

Roberts J, Jenkins C, Wilson R, Pearson C, Franklin IA, MacLean MA, et al. Recurrent miscarriage is associated with increased numbers of CD5/20 positive lymphocytes and an increased incidence of thyroid antibodies. Eur J Endocrinol. 1996;134(1):84-6.

Lazarus JH. Screening for thyroid dysfunction in pregnancy: is it worthwhile? J Thyroid Res. 2011;2011:397012.

Davis LE, Leveno KJ, Cunningham FG. Hypothyroidism complicating pregnancy. Obstet Gynecol. 1988;72(1):108-12.

Leung AS, Millar LK, Koonings PP. Perinatal outcome in hypothyroid pregnancies. Obstet Gynecol. 1993; 81(3):349-53.

Ohara N, Tsujino T, Mauro T. The role of thyroid hormone in trophoblast function, early pregnancy maintainence and fetal neurodevelopment. J Obstet Gynaecol Can. 2004;26(11):982-90.

Donmez M, Sisli T, Atis A, Aydin Y. Spontaneous abortions and thyroid functions. Perinat J. 2005;13(7):110-4.

Speroff L, Fritz MA. Clinical Gynaecology and infertility. 7th ed. Philadelphia: Lippincott Williams and Wilkins; 2005: 815.