Observational comparative study in pregnant females between normal thyroid profile and subclinical hypothyroidism in first trimester and its effect on pregnancy and fetomaternal outcome
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20252319Keywords:
Subclinical hypothyroidism, Maternal outcome, Neonatal outcomeAbstract
Background: Subclinical hypothyroidism (SH) by definition means there is increased in serum thyroid stimulating hormone (TSH) and normal free T4 and free T3. Normal range of serum TSH according to trimester is given below (as per American Thyroid Association and Endocrine Society Clinical Practice Guidelines recommendations): 1st trimester: 0.1 to 2.5 mIU/l; 2nd trimester: 0.2 to 3.0 mIU/l; 3rd trimester: 0.3 to 3.0 mIU/l. Numerous studies have demonstrated association of SH with adverse pregnancy related outcome while some studies found no association. This study was conducted to study about SH in pregnancy and its impact on fetomaternal outcomes.
Methods: This was a hospital based prospective case control study, conducted on 100 women taking routine antenatal care between year 2023 and 2024. The participants were divided into two groups - case: antenatal women in 1st trimester with SH, and control: antenatal women with 1st trimester with normal thyroid profile. These women were followed till their delivery and their maternal and neonatal outcomes were compared.
Results: Women with SH reported increased risk of complications (anaemia, preeclampsia, postdatism, oligohydramnios, more NICU admissions and low APGAR score).
Conclusions: Evaluation for altered thyroid profile in early pregnancy should be done routinely and timely intervention for treatment even for subclinical hypothyroidism to be done. It will lead to decrease in all complications and will improve the maternal and neonatal outcome.
Metrics
References
Patwari M, Talukdar B, Waanbah BD. Study of thyroid profile in pregnancy with perinatal outcome. N Indian J OBGYN. 2016;2(2):73-7.
Cunningham F, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams obstetrics. 25th Edition. McGraw-Hill Education. 2018.
Gietka-Czernel M, Glinicki P. Subclinical hypothyroidism in pregnancy: controversies on diagnosis and treatment. Pol Arch Intern Med. 2021;131:266-75. DOI: https://doi.org/10.20452/pamw.15626
Maraka S, Ospina NM, O'Keeffe DT, Espinosa De Ycaza AE, Gionfriddo MR, et al. Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis. Thyroid. 2016;26(4):580-90.
Dhanwal DK. Thyroid disorders and bone mineral metabolism. Indian J Endocrinol Metab. 2011;15(2):S107-12. DOI: https://doi.org/10.4103/2230-8210.83339
Gupta P, Jain M, Verma V, Gupta NK. The Study of Prevalence and Pattern of Thyroid Disorder in Pregnant Women: A Prospective Study. Cureus. 2021;13(7):e16457. DOI: https://doi.org/10.7759/cureus.16457
Nadagoudar S, Devi LA. The study of maternal and fetal outcome in pregnant women with thyroid disorders. Int J Reprod Contracept Obstet Gynecol. 2017;6(8):3507-13. DOI: https://doi.org/10.18203/2320-1770.ijrcog20173473
Vaidya B, Anthony S, Bilous M, Shields B, Drury J, Hutchison S. Detection of thyroid dysfunction in early pregnancy: universal screening or targeted high-risk case finding? J Clin Endocrinol Metab. 2007;92(1)203-7. DOI: https://doi.org/10.1210/jc.2006-1748
Jagun OE, Andu BA, Olawale OO. Subclinical hypothyroidism among infertile women at a tertiary hospital in South-West Nigeria. Afr Health Sci. 2022;22(2):444-50. DOI: https://doi.org/10.4314/ahs.v22i2.51
Verma I, Sood R, Juneja S, Kaur S. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012;2(1):17-9. DOI: https://doi.org/10.4103/2229-516X.96795
Pavanaganga A. Observational study of subclinical hypothyroidism in pregnancy. Indian J Obstet Gynaecol Res. 2015;2(4):225-60. DOI: https://doi.org/10.5958/2394-2754.2015.00026.0
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 Foetal outcome. J Obstet Gynaecol India. 2013;64(2)105-10. DOI: https://doi.org/10.1007/s13224-013-0487-y
Saraladevi R, Nirmala Kumari T, Shreen B, Usha Rani V. Prevalence of thyroid disorder in pregnancy and pregnancy outcome. IAIM. 2016;3(3):1.
Sahu MT, Das V, Mittal S, Agarwal A, Sahu M. Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and Foetal outcome. Arch Gynecol Obstet. 2010;281(2):215. DOI: https://doi.org/10.1007/s00404-009-1105-1
Pokhanna J, Gupta U, Alwani M, Tiwari SP. Prevalence of thyroid dysfunction and impact on maternal and Foetal outcome in Central Indian pregnant women. Int J Reprod Contraception, Obstet Gynecol. 2017;64666-70. DOI: https://doi.org/10.18203/2320-1770.ijrcog20174461
Tanuja PM, Rajgopal K, Sadiqunnisa. Thyroid dysfunction in pregnancy and maternal outcome. IOSR-JDMS. 2014;13(1):11-5. DOI: https://doi.org/10.9790/0853-131101115
Rajput R, Goel V, Nanda S, Rajput M, Seth S. Prevalence of thyroid dysfunction among women during the first trimester of pregnancy at a tertiary care hospital in Haryana. Indian J Endocrinol Metab. 2015;19(3):416-9. DOI: https://doi.org/10.4103/2230-8210.152791
Maraka S, Singh NM, Ospina, Mastorakos G, O’Keeffe DT. Subclinical Hypothyroidism in Women Planning Conception and During Pregnancy: Who Should Be Treated and How? J Endocr Soc. 2018;2(6):533-46. DOI: https://doi.org/10.1210/js.2018-00090
He Y, He T, Wang Y, Xu Z, Xu Y, Wu Y, et al. Comparison of the effect of different diagnostic criteria of subclinical hypothyroidism and positive TPO-Ab on pregnancy outcomes. Zhonghua Fu Chan Ke Za Zhi. 2014;49(11):824-8.
Deshauer S, Wyne A. Subclinical hypothyroidism in pregnancy. CMAJ. 2017;189(28):E941. DOI: https://doi.org/10.1503/cmaj.161388
Maraka S, Ospina NM, O'Keeffe DT, Espinosa De Ycaza AE, Gionfriddo MR, et al. Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis. Thyroid. 2016;26(4):580-90. DOI: https://doi.org/10.1089/thy.2015.0418
Sharma D, Dixit PV, Gavit Y. Maternal and perinatal outcome in hypothyroidism in pregnancy: a prospective observational study. Int J Reprod Contracept Obs Gynecol. 2017;6(12)5548-55. DOI: https://doi.org/10.18203/2320-1770.ijrcog20175279
Mahadik, K., Choudhary, P. & Roy, P.K. Study of thyroid function in pregnancy, its feto-maternal outcome; a prospective observational study. BMC Pregnancy Childbirth. 2020;20:769. DOI: https://doi.org/10.1186/s12884-020-03448-z
Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R; American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21(10):1081-25. DOI: https://doi.org/10.1089/thy.2011.0087
Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004;291(2):228-38. DOI: https://doi.org/10.1001/jama.291.2.228
Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, McDermott MT. Subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and the Endocrine Society. J Clin Endocrinol Metab. 2005;90(1):581-5. DOI: https://doi.org/10.1210/jc.2004-1231
Abalovich M, Gutierrez S, Alcaraz G, Maccallini G, Garcia A, Levalle O. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid. 2002;12(1):63-8. DOI: https://doi.org/10.1089/105072502753451986
Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2005;105(2):239-45. DOI: https://doi.org/10.1097/01.AOG.0000152345.99421.22
Downloads
Published
How to Cite
Issue
Section
