Prevalence of hypothyroidism amongst pregnant women: a study done in rural set up

Nancy S. Pillai, Jemela Bennet


Background: Thyroid disorders are the commonest endocrine disorders affecting women of reproductive age group. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. During early pregnancy the foetus is totally dependent on maternal thyroid hormone supply. Thyroid hormone is critical for foetal brain and intellectual development and some preventable conditions like abruption, pre-eclampsia etc. which produce morbidity and pose special risk for pregnancy and the developing foetus.

Methods: All subjects enrolled in the study as per the inclusion criteria will be subjected to a detailed history and clinical examination using a predesigned proforma. A serum TSH value will be sent in 1st trimester between 6-10 weeks period of gestation for all pregnant women.

Results: The prevalence of thyroid dysfunction in pregnancy was 10.8% with hypothyroidism being 9.2%, out of which 8.5% were cases of subclinical hypothyroidism and 0.7% were cases of overt hypothyroidism. On assessing the risk factors for developing thyroid dysfunction in pregnancy, increases in incidence were seen with maternal age and increasing BMI, both of which were statistically significant.

Conclusions: This study showed an increased prevalence of hypothyroidism in pregnancy recommending a need for universal screening for all pregnant women in the first trimester itself. This study aims at validating the efficacy of the above-mentioned screening.


Hypothyroidism in pregnancy, Prevalence, Screening

Full Text:



Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev. 1997;18:404-33.

Casey BM, Leveno KJ. Thyroid diseases in pregnancy. Obstet Gynecol. 2006;108:1283-92.

Jagtap NV. Prevalence and impact of thyroid disorders on maternal outcome in Asian-Indian pregnant women. J Thyroid Res. 2011;429097.

Sahu MT, Das V. Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and foetal outcome. Arch Gynecol Obstet. 2010;2812:215-20.

Davis LE, Leveno KJ, Cunningham FG. Hypothyroidism complicating pregnancy. Obstet Gynecol. 1988;72(1):108-s12.

Leung AS, Millar LK, Koonings PP, Montoro M, Mestman JH. Perinatal outcome in hypothyroid pregnancies. Obstet Gynecol. 1993;81(3):349-53.

Allan WC, Haddow JE, Palomaki GE. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen. 2000;7(3):127-30.

Abalovich M, Gutierrez S, Alcaraz G, Maccallini G, Garcia A, Levalle O. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid. 2002;12(1):63-8.

Casey BM, Dashe JS, Wells CE. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2005;105(2):239-45.

Negro R, Schwartz A. Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5 in the first trimester of pregnancy. J Clin Endocrinol Metab. 2010;95:E44-8.

Van-Raaij JM. Energy requirements of pregnancy in the Netherlands Lancet. 1987;2:953-5.

Le Bean SO, Mandal SJ. Thyroid disorders during pregnancy. Endocrinal Metab Clin N Am. 2006;35:117-36.

Glinoer D, Spencer CA. Serum TSH determinations in pregnancy: how, when and why?. Nature Rev Endocrinol. 2010;6(9):526-9.

Garber JR, Cobin RH, Gharib H. Clinical practice guidelines for hypothyroidism in adults: co-sponsored by American Association of Clinical Endocrinologists and the American Thyroid Association. Endoc Pract. 2012;11:1-207.

Ecker JL, Musci TJ. Treatment of thyroid disease in pregnancy. Presc Preg. 1997;24:575-89.

De Groot L, Abalovich M, Alexander EK. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clinic Endocrinol Metab. 2012;97(8):2543-65.

Stagnaro-Green A, Abalovich M, Alexander E. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21(10).

Clinical Practice Guidelines New Delhi: Elsevier; 2012. Indian Thyroid Society guidelines for management of thyroid dysfunction during pregnancy.

Atomare M, Vignesa LA. High prevalence of thyroid dysfunction in pregnant women. J Endocrinal Invest. 2013;36:407-11.

Blall AJ, Nakamoto JM. National status of testing for hypothyroidism during pregnancy and postpartum. J Clin Endocrinal Metab. 2012;97:777-84.

Mosso L, Martínez A, Rojas MP, Margozzini P, Solari S, Lyng T, et al. Frequency of subclinical thyroid problems among women during the first trimester of pregnancy. Revista medica de Chile. 2012 Nov;140(11):1401-8.

Dhanwal DK, Prasad S, Agarwal AK, Dixit V, Banerjee AK. High prevalence of subclinical hypothyroidism during first trimester of pregnancy in North India. Indian J Endocrinol Metab. 2013;17(2):281.

Goel P, Kaur J, Saha PK, Tandon R, Devi L. Prevalence, associated risk factors and effects of hypothyroidism in pregnancy: a study from north India. Gynecologic Obstet Invest. 2012;74(2):89-94.

Gayathri R, Lavanya S, Raghavan K. Subclinical Hypothyroidism and Autoimmune Thyroiditis in Pregnancy: A study in South Indian Subjects. JAPI. 2009;57:691-3.

Vaidya B, Anthony S, Bilous M, Shields B, Drury J, Hutchison S, Bilous R. Detection of thyroid dysfunction in early pregnancy: universal screening or targeted high-risk case finding?. J Clinic Endocrinol Metab. 2007 Jan 1;92(1):203-7.

Negro R, Formoso G. Levothyroxin treatment in Euthyroid pregnant women with auto immune thyroid immune disease: effects on obstetrical complications. J Clin Endocrinol Metab. 2006;91(7):2587-91.

Tunbridge WM, Evered DC. The spectrum of thyroid disease in a community: The Wickham survey. Clin Endocrinol. 1997;7:481-93.

Wang C, Crap LM. The epidemiology of thyroid disease and implications for screening. Endocrinol Metab Clin North Am. 1997;26:189-218.

Saikh MG, Anderson JM. Transient neonatal hypothyroidism due to maternal vegan diet. J Pediatr Endocrinol Metab. 2003;16:111-3.

Knudsen N, Laurberg P, Rasmussen LB, Bülow I, Perrild H, Ovesen L, Jørgensen T. Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. J Clinic Endocrinol Metab. 2005;90(7):4019-24.

Manji N, Boelaert K, Sheppard MC, Holder RL, Gough SC, Franklyn JA. Lack of association between serum TSH or free T4 and body mass index in euthyroid subjects. Clinic Endocrinol. 2006;64(2):125-8.

Figueroa B, Vélez H, Irizarry-Ramirez M. Association of thyroid-stimulating hormone levels and body mass index in overweight Hispanics in Puerto Rico. Ethn Dis. 2008;18:S2151-4.

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.

Wang W, Teng W, Shan Z. The prevalence of thyroid disorder during early pregnancy in China: the benefits of universal screening in the first trimester of pregnancy. Eur J Endocrinol. 2011;164(2):263.

Potlukova E, Potluka O, Jiskra J, Limanova Z, Telicka Z, Bartakova J, et al. Is age a risk factor for hypothyroidism in pregnancy? An analysis of 5223 pregnant women. J Clinic Endocrinol Metab. 2012;97(6):1945-52.