Role of anti-thyroid peroxidase antibodies in adverse pregnancy outcomes
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20162973Keywords:
Anti-TPO Ab, TSH, AbortionsAbstract
Background: Because of the link of thyroid auto antibodies with various pregnancy related complications and anti-thyroid peroxidase antibody (TPO Ab) being most common of all of them, can be used as a surrogate marker for thyroid related adverse pregnancy outcomes. Hence, present study was designed to further elucidate any association of anti-TPO antibodies and serum thyroid stimulating hormone (TSH) levels with adverse pregnancy outcomes.
Methods: This observational study has been conducted in the department of obstetrics and gynaecology at L. L. R. M. Medical College, Meerut, Uttar Pradesh, India. Five hundred randomly selected peripartum women from 20 weeks onwards have been included and divided into two main groups, anti-TPO Ab positive (group B) and anti-TPO Ab negative (group A). Serum TSH was done only in group B. These two groups were compared for age of the patient, period of gestation, number of abortions, pregnancy outcome, maternal and fetal complications.
Results: Out of 500 women, 18.6% were anti-TPO Ab positive. Number of abortions ≥ 2 was found in 18% and 8% in group B and A whereas preterm delivery was found in 50% and 17% in the two groups respectively. In group B, 48% had increased TSH.
Conclusions: Anti-TPO Ab presence was significantly associated with preterm deliveries, recurrent abortions, increased maternal and fetal complications.
References
McElduff A, Morris J. Thyroid function tests and thyroid autoantibodies in an unselected population of women undergoing first trimester screening for aneuploidy. Aust NZJ Obstet Gynaecol. 2008;48:478-80.
Stagnaro-Green A, Roman SH, Cobin RH, el-Harazy E, Alvarez-Marfany M, Davies TF. Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. JAMA. 1990;264:1422-5.
Casey BM, Dashe JS, Wells CE, Mclntire DD, Byrd W, Leveno KJ, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2005;105:239-45.
Casey BM, Dashe JS, Spong CY, Mclntire DD, Leveno KJ, Cunningham GF. Perinatal significance of isolated maternal hypothyroxinemia identified in the first half of pregnancy. Obstet Gynecol. 2007;109:1129-35.
Barber WA, Fernando M, Chadwick DR. Plasma cell granuloma of the thyroid: a conservative approach to a rare condition and review of the literature. J Thyroid Res, 2010. Available at http://www.sage-hindawi.com/journals/jtr/2010/840469.html. Accessed on 15 June 2015.
Cleary-Goldman J, Malone FD, Lambert-Messerlian G, Sullivan L, Canick J, Porter TF, et al. Maternal thyroid hypofunction and outcome. Obstet Gynecol. 2008;112:85-92.
Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychologilcal development of the child. N Engl J Med. 1999;341:549-55.
Pop VJ, Kuijpens JL, van Baar AL, Verkerk G, van Son MM, de Vijlder JJ, et al. Low maternal free thyroxine concentrations during early pregnancy are associated with impaired psychomotor development in infancy. Clin Endocrinol (Oxf). 1999;50:149-55.
Pop VJ, Brouwers EP, Vader HL, Vulsma T, van Baar AL, de Vijlder JJ. Maternal hypothyroxinemia during early pregnancy and subsequent child development: a 3-year follow-up study. Clin Endocrinol (Oxf). 2003;59:282-8.
Kuijpens JL, De Hann-Meulman M, Vader HL, Pop VJ, Wiersinga WM, Drexhage HA. Cell-mediated immunity and postpartum thyroid dysfunction: a possibility for the prediction of the disease? J Clin Endocrinol Metab. 1998;83:1959-66.
Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinil Metab. 2006;91:2587-91.
Poppe K, Glinoer D. Thyroid autoimmunity and hypothyroidism before and during pregnancy. Hum Reprod Update. 2003;9:149-61.
Glinoer D, de Nayer P, Bourdoux P, Lemone M, Robyn C, van Steirteghem A, et al. Regulation of maternal thyroid during pregnancy. The Journal of Clinical Endocrinology and Metabolism. 1990;71(2):276-87.
Stagnaro-Green A, Roman SH, Cobin RH, El-Harazy E, Alvarez-Marfany A, Davies TF. Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. Journal of the American Medical Association. 1990;264(11):1422-5.
Prummel MF, Wiersinga WM. Thyroid autoimmunity and miscarriage. European Journal of Endocrinology. 2004;150(6):751-5.
Glinoer D, Soto MF, Bourdoux P, Lejeune B, Delange F, Lemone M, et al. Pregnancy in patients with mild thyroid abnormalities: maternal and neonatal repercussions. Journal of Clinical Endocrinology and Metabolism. 1991;73(2):421-7.
Nakamura H, Usa T, Motomura M, Ichikawa T, Nakao K, Kawasaki E, et al. Prevalence of interrelated autoantibodies in thyroid diseases and autoimmune disorders. J Endocrinol Invest. 2008;31:8615.
Challis JR, Lockwood CJ, Myatt L, Norman JE, Strauss JF, Petraglia F. Inflammation and pregnancy. Reprod Sci. 2009;16:206-15.
Glinoer D. Miscarriage in women with positive anti TPO antibodies: is thyroxine the answer? J Clin Endocrinol Metab. 2006;91:250-2.