The study of maternal and fetal outcome in pregnant women with thyroid disorders
Keywords:Hyperthyroidism, Hypothyroidism, Oligohydromnios, PIH, Pregnancy, Thyroid dysfunction
Background: Thyroid disorders are among the common endocrine disorders in pregnant women after diabetes mellitus. Several changes are observed in maternal thyroid function during pregnancy and failure to adapt to these physiological changes results in thyroid dysfunction. It is well established that not only overt, but subclinical thyroid dysfunction also has adverse effect on mother and the fetus, like miscarriages, preterm delivery, preeclampsia, eclampsia, polihydromnios, placental abruption, post-partum haemorrhage, low birth weight, neonatal hypothyroidism. Decreased availability of thyroid hormones may also impair neurological and intellectual development of foetus. With this background, we are conducting a study to know the effect of thyroid disorders on pregnancy and its maternal and the fetal outcome.
Methods: The present study was conducted in ESI Hospital Rajaji Nagar, Bangalore. It is a prospective study which involved 100 patients diagnosed to have thyroid disorder during their antenatal checkup in the first trimister. It also includes known cases of thyroid disorder. TSH level was estimated. If it is deranged, then FT3 and FT4 levels estimated. Patients were managed accordingly and followed till delivery. Their obstetric and perinatal outcomes were noted.
Results: In our study out of 100 cases, 96 cases are subclinical hypohyroid and 4 cases are subclinical hyperthyroid. Subclinical hypothyroidism in pregnancy are associated with abortions (2.1%), Anaemia (4.20%), PIH (14.7%), GDM (4.2%), Preterm labour (3.1%), oligohydromnios (16.67%), Lscs (22.9%), PPH (6.3%), LBW (21.9%), Hyperbilirubinemia (9.4%), NICU admission (14.6%), Which are co-relatine with other studies and hyperthyroid cases in our study were not sufficient for outcome analysis.
Conclusions: Thyroid disorders in pregnancy have adverse effects on maternal and fetal outcome emphasizing the importance of routine antenatal thyroid screening.
Gupta K. Thyroid disorders and pregnancy. FOGSI FOCUS- Medical Disorders in pregnancy. 2009;10:59-66.
Belfort MA. Thyroid and other endocrine emergencies. Obst Intensive Care Man 2nd ed. New Delhi: Tata Mcgraw-hill. 2005:120-42.
Sahasrabudde A, Pitale S. Screening for thyroid dysfunction during pregnancy. Thyroid Res Pract. 2012;9:15-7.
Wilson GR, Curry RW. Subclinical Thyroid Disease. Am Fam physician. 2005;72(8):1517-24.
Reid SM, Middleton P, Cossich MV, Crowther CA. Interventions for clinical and subclinical hypothyroidism in pregnancy Cochrane Database Syst Rev. 2010;7:CD007752.
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.
Vaidhya B, Anthony S, Bilous M, Shields B, Drury J, Hutchison S, Bilous R. Detection of Thyroid dysfunction in early pregnancy: Universal screening ot Targeted High risk case finding? J Clin Endocrinol Metab. 2007;92(1):203-7.
Goel P, Radotra A, Devi K, Malhotra S, Aggaewal A, Huria A. Maternal and perinatal outcome in pregnancy with hypothyroidism. Indian J Med Sci. 2005;59(3):116-7.
Stagnaro-Green A. Overt hyperthyroidism and Hypothyroidism during pregnancy. Clin Obstet Gynecol. 2011;54(3):478-87.
Tiwari BD, Godbole MM, Chattopadhyay N, Manda A, Mithal A. Learning disabilities and poor motivation to achieve dur to prolonged iodine deficiency. Am J Clin Nutr.1996;63(5):782-6.
Kapil U, Patak P, Tandom M, Singh C, Pradhan R, Dwivedi SN. Micronutrient deficiency disorders among pregnant women in three urban slum communities of Delhi. Indian Pediatr. 1999;36(10):991-8.
Marx H, Amin P, Lazarus J. Hyperthyroidism and pregnancy. BMJ. 2008;336:663-7.
Kasper DL, Braunwald E. Disorders of thyroid gland. harrison’s principles of internal medicine. 16th edition. 2005;2:2104-26.
Sujit C. The Thyroid, Medical Physiology 6th edition;2008:276-81.
Kim E Barrett, Barman SM. The thyroid gland. Ganong’s Review of medical physiology, 23rd edition; 2010:301-40.
Guyton, Hall. Thyroid Metabolic Hormones. Textbook of Medical Physiology, 11th edition; 2006:931-43.
Tanuja PM, Rajgopal K, Sadiqunnisa. Thyroid dysfunction in pregnancy and maternal outcome. IOSR-JDMS. 2014;13(1):11-15.
Studd J. Thyroid Hormones in pregnancy and foetus. 15th edition;75-102.
Banarjee S. Thyroid disorders in pregnancy. JAPI. 2011;59:32-34.
Girling J. Thyroid disease in pregnancy. Obstet Gynecol Reprod Medic. 2008;18:10.
Gaberšček S, Zaletel K. Thyroid physiology and autoimmunity in pregnancy and after delivery. Expert Rev Clin Immunol. 2011;7(5):697-707.
Pavanaganga A. Observational study of subclinical hypothyroidism in pregnancy. Indian J Obstet Gynaecol Res. 2015:2(4):225-60.
Ozdemir H, Akman I, Coskun S, Demirel U, Turan S, Bereket A et al. Maternal thyroid dysfunction and Neonatal thyroid problems. Int J Endocrinol. 2013;2013:987843.
Mohammed MZ, Chandrashekar K. Clinical study of pregnancy with hypothyroidism and its outcome in Tertiary care hospital. J Evol Med Dental Sci. 2015;4(94):15927-9.
George M, George SM, Jayashree Thankachi VM. Hypothyroid in pregnancy screen or not. J Evol Med Dent Sci. 2015;4(29):4973-8.
Lauberg P, Anderson S, Bjarnadottir RI. Evaluating iodine deficiency in pregnant women and young infants-complex physiology with a risk of is interpretation. Public Health Nutr. 2009;10(12A):1547-52.
Glinoer D, De Nayer P, Bourdoux P. Regulation of maternal thyroid during pregnancy. J Clin Endocrinol Metab.1990;71(2):276-87.
Schussler GC. The thyroxine-binding proteins. Thyroid. 2000;10(2):141-9.
Zhou A, Wei Z, Read RJ, Carrell RW. Structural mechanism for carriage and release of thyroxine in the blood. Proc Natl Acad Sci USA 2006;3(36):13321-6.
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.
Meena DS, Bhati I, Bora S, Meena S. Study of thyroid dysfunction in pregnancy. Int J Curr Microbiol App Sci. 2015;4(9):91-7.
Leung AS, Millar LK, Kooning PP, Montorom, Mestman J. Perinatal outcome in hypothyroid pregnancies. Obstet Gynecol. 1993:81(3):349-53.
Hareesh MV, Bijju A, Steephan S. The profile of infants born to mothers with subclincical hypothyrodism in tertiary care centre. IOSR-JDMS. 2015;14(11):42-46.