Pregnancy outcome in women treated for subclinical hypothyroidism detected in early gestation
Keywords:Gestational hypertension, Gestational diabetes mellitus, Subclinical hypothyroidism, Thyroxine
Background: Thyroid disorders are among the most common endocrine disorders in pregnancy. Objective of present study were to investigate the outcome of pregnancy in those women detected to have subclinical hypothyroidism in early gestation and to evaluate whether treatment of subclinical hypothyroidism reduces the adverse pregnancy outcome.
Methods: Pregnant women detected to have Subclinical hypothyroidism (TSH >2.5- 6 mU/L and N Free T4) in the 1st trimester were selected and randomly divided into 2 groups. One group received treatment with Thyroxine. They were followed up till delivery and outcome noted.
Results: The mean maternal age of both the group was 26 yrs. The gestational age at delivery and the newborn birth weight did not show any statistically significant difference. Antenatal complications like Gestational Diabetes, hypertension, small for gestation, and preterm were almost the same in both groups. There was significant increase in the primary caesarean rate in the treated group. No significant difference in the number of term vaginal delivery in both groups.
Conclusions: Treatment of women with SCH (TSH <6 mU/L) does not reduce the risk of adverse pregnancy outcome. Benefits of treatment need to be weighed against any potential risks.
Dhanwal DK, Bajaj S, Rajput R, Subramaniam KA, Chowdhury S, Bhandari R et al. Prevalence of hypothyroidism in pregnancy: An epidemiological study from 11 cities in 9 states of India. Indian J Endocrinol Metab. 2016;20(3):387-90.
Radha KR, Sugunan N, Resmy CR. Cross sectional study in a rural tertiary care centre in Kerala, India, do we need to screen and treat pregnant women for Subclinical hypothyroidism?. IJRCOG. 2017;6(3):781-6.
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 Oct;21(10):1081-125.
Sullivan SA. Subclinical hypothyroidism: Identification and treatment in pregnancy. Contemporary Ob/Gyn Womens Health. 2011.
Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, Cunningham FG. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2005 Feb;105(2):239-45.
Wilson KL, Casey BM, McIntire DD, Halvorson LM, Cunningham FG. Subclinical thyroid disease and the incidence of hypertension in pregnancy. Obstet Gynecol. 2012 Feb;119(2, Part 1):315-20.
Tudela CM, Casey BM, McIntire DD, Cunningham FG. Relationship of subclinical thyroid disease to the incidence of gestational diabetes. Obstet Gynecol. 2012 May;119(5):983-8.
Nelson DB, Casey BM, McIntire DD, Cunningham FG. Subsequent pregnancy outcomes in women previously diagnosed with subclinical hypothyroidism. Am J Perinatol. 2014 Jan;31(01):077-84.
Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL et al. Williams Obstetrics. Endocrine disorders. 24th ed. McGraw-Hill Global Education Holdings, LLC;2014:1154-5.
Cleary-Goldman J, Malone FD, Lambert-Messerlian G, Sullivan L, Canick J, Porter TF et al. Maternal thyroid hypofunction and pregnancy outcome. Obstetrics and gynecology. 2008 Jul;112(1):85.
Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. The J Clin Endocrinol Metab. 2010 Apr;95(4):1699-707.
Männistö T, Vääräsmäki M, Pouta A, Hartikainen AL, Ruokonen A, Surcel HM et al. Perinatal outcome of children born to mothers with thyroid dysfunction or antibodies: a prospective population-based cohort study. J Clin Endocrinol Metab. 2009 Mar 1;94(3):772-9.
Casey BM, Thom EA, Peaceman AM, Varner MW, Sorokin Y, Hirtz DG et al. Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy. N Engl J Med. 2017 Mar 2;376(9):815-25.