Thyroid dysfunction and hypertensive disorders in pregnancy: a retrospective study stratified by gestational age and maternal thyroid profile

Meenakshi Thakur; Deepti Rana; Meenakshi Verma

doi:10.18203/2320-1770.ijrcog20253083

Authors

Meenakshi Thakur Department of Obstetrics and Gynecology, Dr Rajendra Prasad Government Medical College, Tanda, Kangra Himachal Pradesh, India
Deepti Rana Department of Obstetrics and Gynecology, Dr Rajendra Prasad Government Medical College, Tanda, Kangra Himachal Pradesh, India
Meenakshi Verma Department of Obstetrics and Gynecology, Dr Rajendra Prasad Government Medical College, Tanda, Kangra Himachal Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20253083

Keywords:

Antihypertensives, Gestational hypertension, IUGR, Parity, Preeclampsia, Subclinical hypothyroidism

Abstract

Background: Thyroid dysfunction has been increasingly implicated in the development of hypertensive disorders in pregnancy (HDP), though its influence on gestational age of onset, fetal outcomes, and disease severity remains underexplored. The roles of maternal parity, intrauterine growth restriction (IUGR), and antihypertensive management strategies in this context are also not well established.

Methods: A retrospective study was conducted at a tertiary care center in North India over 3 years (2022–2025), including pregnant women diagnosed with HDP after 20 weeks of gestation. Thyroid function tests (TSH, FT4) were correlated with HDP type, gestational age at onset, parity, presence of IUGR, and antihypertensive therapy used.

Results: Among 384 women with HDP, 114 (29.7%) had thyroid dysfunction 96 (25%) with subclinical and 18 (4.7%) with overt hypothyroidism. Thyroid abnormalities were more prevalent in women with early-onset HDP (<34 weeks) and in primigravidae. IUGR was observed in 41.2% of patients with thyroid dysfunction compared to 22.9% in euthyroid women (p<0.01). Subclinical hypothyroidism was strongly associated with preeclampsia and eclampsia. The most commonly prescribed antihypertensive agents were labetalol (74.1%) and nifedipine (62.5%), with higher use of dual therapy in patients with overt hypothyroidism.

Conclusions: Thyroid dysfunction, particularly subclinical hypothyroidism, is significantly associated with early-onset and severe hypertensive disorders, higher incidence of IUGR, and increased need for combination antihypertensive therapy. Routine thyroid screening in antenatal care, especially in primigravidae, may facilitate early risk identification and targeted management.

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References

Kumar A, Gupta V, Mishra S, Sharma N, Kulshreshtha B. Thyroid dysfunction and pregnancy outcomes. Ind J Endocrinol Metab. 2013;17(2):294-7.

Dhanwal DK, Prasad S, Agarwal AK, Dixit V, Banerjee AK. High prevalence of subclinical hypothyroidism during first trimester of pregnancy in North India. Ind J Endocrinol Metab. 2013;17(2):281-4. DOI: https://doi.org/10.4103/2230-8210.109712

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 fetal outcome. Arch Gynecol Obstet. 2010;281(2):215-20. DOI: https://doi.org/10.1007/s00404-009-1105-1

Wilson KL, Casey BM, McIntire DD, Halvorson LM, Cunningham FG. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2012;119(2 Pt 1):265-71. DOI: https://doi.org/10.1097/AOG.0b013e318240de6a

Cleary-Goldman J, Malone FD, Lambert-Messerlian G, Sullivan L, Canick J, Porter TF, et al. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol. 2008;112(1):85-92. DOI: https://doi.org/10.1097/AOG.0b013e3181788dd7

Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21(10):1081-125. DOI: https://doi.org/10.1089/thy.2011.0087

Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd EW, 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

Leung AS, Millar LK, Koonings PP, Montoro MN, Mestman JH. Perinatal outcome in hypothyroid pregnancies. Obstet Gynecol. 1993;81(3):349-53. DOI: https://doi.org/10.1016/0020-7292(93)90343-U

Vaidya B, Anthony S, Bilous M, Shields B, Drury J, Hutchison S, et al. 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

American College of Obstetricians and Gynecologists. Gestational hypertension and preeclampsia: ACOG Practice Bulletin No. 222. Obstet Gynecol. 2020;135(6):e237-60. DOI: https://doi.org/10.1097/AOG.0000000000003891

National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management (NG133). London: NICE; 2019.

Maraka S, Ospina NM, O’Keeffe DT, Espinosa De Ycaza AE, Gionfriddo MR, Erwin PJ, 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

Negro R, Stagnaro-Green A. Diagnosis and management of subclinical hypothyroidism in pregnancy. BMJ. 2014;349:g4929. DOI: https://doi.org/10.1136/bmj.g4929

Wang S, Teng WP, Li JX, Wang WW, Shan ZY. Effects of maternal subclinical hypothyroidism on obstetrical outcomes during early pregnancy. J Endocrinol Invest. 2012;35(3):322-5.

Korevaar TIM, Derakhshan A, Taylor PN, Meima M, Chen L, Bliddal S, et al. Association of thyroid function test abnormalities and thyroid autoimmunity with preterm birth: a systematic review and meta-analysis. JAMA. 2019;322(7):632-41. DOI: https://doi.org/10.1001/jama.2019.10931

Yu X, Chen L, Zhang W, Xu W, Zhang L, Shen J, et al. Maternal subclinical hypothyroidism, thyroid autoimmunity, and risk of preeclampsia: a systematic review and meta-analysis. Endocr. 2017;55(1):12-20.

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 Gynaecol India. 2014;64(2):105-10. DOI: https://doi.org/10.1007/s13224-013-0487-y

Mankar J, Varma TR, Jindal S, Banerjee M. Maternal thyroid dysfunction and obstetric outcomes: a prospective observational study. Int J Reprod Contracept Obstet Gynecol. 2017;6(1):54-9.

Mahadik K, Choudhary P, Roy PK. Study of thyroid profile in pregnancy and its association with pregnancy outcomes. Indian J Endocrinol Metab. 2016;20(4):508-11.

Sinha S, Bharti R, Gutch M, Kumar S, Gupta KK. Thyroid disorders in pregnancy and their effect on maternal and fetal outcome. J Clin Diagn Res. 2018;12(2):QC12-5.