Prevalence of hypothyroid dysfunction among third trimester pregnant women and its effect on maternal and fetal outcome
Keywords:Sub clinical hypothyroidism, Thyroid stimulating hormone, Overt hypothyroidism
Background: Thyroid disorders are the predominant endocrinological afflictions of pregnancy that if were to affect the mother and her child, would lead to various complications.
Methods: A randomized study among 450 third trimester admitted cases for any indication were subjected to thyroid functions by TSH, Free T4 and TPO Ab. Total 61 mothers (54 hypothyroidism and 7 sub clinical hyperthyroidism) had thyroid dysfunction. These 54 hypothyroid mothers were further evaluated during the remaining course of gestation for feto-maternal outcomes.
Results: Out of 450 third trimester ANC cases 61(13.5%) had deranged thyroid functions in third trimester. Out of 61patients, 18 (29.50%) patients had TPO Ab positive. Prevalence of subclinical hypothyroidism, overt hypothyroidism, and subclinical hyperthyroidism was 9.6%, 2.45%, and 1.5%, respectively. Anemia was found in 9.3% of SCH and 27.3% cases in OH cases. Preeclampsia was found in 16.2% cases of SCH and 18.2% cases in OH cases. Gestational diabetes mellitus was noticed among 16.27% cases of SCH and 18.18% cases of OH. Previous abortions were present among 65.1% cases of SCH and 45.45% cases of OH. Placental abruption and cardiac failure were observed in 4.65% and 2.34% of SCH only. Cesarean delivery occurred in 18.6% of SCH and 36.36% of overt hypothyroidism.
Conclusions: This study concludes a high prevalence of thyroid disorders as subclinical hypothyroidism (9.6%), overt hypothyroidism (2.5%) and subclinical hyperthyroidism (1.5%) in third trimester pregnancy.
Alemu A, Terefe B, Abebe M, Biadgo B. Thyroid hormone dysfunction during pregnancy: A review. Int J Reprod Biomed. 2016;14(11):677-86.
Casey BM, Leveno KJ: Thyroid disease in pregnancy. Obstet Gynecol. 2006;108(5):1283-92.
Bajaj S, Chawla T, Gupta P, Chaurasia A, Mehrotra R. Thyroid dysfunction in pregnancy – A tertiary care centre experience. Endocrinol Metab. 2016;6:3-7.
Consortium on Thyroid and Pregnancy: Association of thyroid function test abnormalities and thyroid autoimmunity with preterm birth: a systematic review and meta-analysis. JAMA. 2019;322(7):632.
Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med. 1999;341(8):549-55.
Wang W, WeipingTeng ZS, Wang S, Li J, Zhu L, Zhou J. The prevalence of thyroid disorders during early pregnancy in China: the benefits of universal screening in the first trimester of pregnancy. Eur J Endocrinol. 2011;164(2):263-8.
Ajmani SN, Aggarwal D, Bhatia P, Sharma M, Sarabhai V, Paul M. Prevalence of overt and subclinical thyroid dysfunction among pregnant women and its effect on maternal and fetal outcome. J Obstet Gynecol India. 2014;64(2):105-10.
Abalovich M, Alcaraz G, Kleiman-Rubinsztein J. The relationship of preconception thyrotropin levels to requirements for increasing the levothyroxine dose during pregnancy in women with primary hypothyroidism. Thyroid. 2010;20(10):1175.
Abalovich M, Gutierrez S, Alcaraz G. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid. 2002;12(1):63.
Abbassi-Ghanavati M, Casey B, Spong C. Pregnancy outcomes in women with thyroid peroxidase antibodies. Obstet Gynecol. 2010;116(2, Pt 1):381.
Fein HG, Rivlin RS. Anemia in thyroid diseases. Med Clin N Am. 1975;59(5):1133-45.
Baghel M, Batra J, Thimmaraju KV, Itagappa M. Association of thyroid status with hemoglobin levels in pregnancy. Int J Res Med Sci. 2017;5(11):4873-6.
De Leo S, Pearce EN. Autoimmune thyroid disease during pregnancy. Lancet Diab Endo. 2018;6:575-86.
Manju VK. Maternal outcome in thyroid dysfunction. Int J Reprod Contracept Obstet Gynecol. 2017;6(6):2361-5.
Inversetti A, Serafini A, Manzoni M, Capuzzo A, Valsecchi L, Candiani M. Severe hypothyroidism causing pre-Eclampsia-like syndrome. Case Rep Endocrinol. 2012;2012:586056.
Sreelatha S. The study of maternal and fetal outcome in pregnant women with thyroid disorders. Int J Reprod Contracept Obstet Gynecol. 2017;6(8):3507-13.
Zhou A, Wei Z, Read RJ, Carrell RW. Structural mechanism for carriage and release of thyroxine in the blood. Proc Natl Acad Sci U S A. 2006;3(36):13321-6.
Gupta HP, Kunwar S, Goel S. A study of thyroid dysfunction in antenatal women attending the antenatal clinic in a tertiary care Centre. Int J Health Sci Res. 2015;5(6):111-7.
Aleksander PE, Bruckner-Spieler M, Stoehr AM: Mean high-dose thyroxine treatment is efficient and safe to achieve a normal IQ in young adult patients with congenital hypothyroidism. J Clin Endocrinol Metab. 2018;103(4):1459.
Alexander EK, Pearce EN, Brent GA: 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2017;27(3):315.