Thyroid peroxidase antibody positivity among euthyroid pregnant women and its association with foeto-maternal outcome


  • Kanika Gulati Department of Obstetrics and Gynecology, Mahavir Medical College and Safdarjung Hospital, New Delhi, India
  • Manjula Sharma Department of Obstetrics and Gynecology, Mahavir Medical College and Safdarjung Hospital, New Delhi, India
  • Rekha Bharti Department of Obstetrics and Gynecology, Mahavir Medical College and Safdarjung Hospital, New Delhi, India
  • Krishna Biswas Department of Endocrinology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
  • Achla Batra Department of Obstetrics and Gynecology, Mahavir Medical College and Safdarjung Hospital, New Delhi, India
  • Abha Aggarwal Rtd. National Institute of Medical Statistics, ICMR, New Delhi, India
  • Aruna Batra Department of Obstetrics and Gynecology, SGT University, Budhera, Gurgaon, Haryana, India



Euthyroid, Prevalence, Pregnancy, Thyroid peroxidase antibodies, TPO-Ab


Background: Thyroid peroxidase antibody (TPO-Ab) positivity is associated with increased risk of adverse pregnancy outcomes. The present study was planned to find out the prevalence of TPO-Ab and its association with adverse foeto-maternal outcome in euthyroid pregnant women.

Methods: A total of 510 euthyroid pregnant women with <20 weeks gestation were recruited from antenatal clinic. Serum TPO-Ab testing was done and women were divided into 2 groups. The study group comprised of TPO-Ab positive women and control group comprised of age and parity matched TPO-Ab negative women, double in number to that of the study group. Repeat Serum TSH was done at term/delivery and women were followed till delivery for foeto-maternal outcome.

Results: The prevalence of TPO-Ab positivity in euthyroid pregnant women was 11.3%. A significant number of women in the study group developed hypothyroidism at term/delivery, 18.61% vs 7.61%, respectively, p=0.02. None of the women in the study or control group developed gestational diabetes or placental abruption, or had babies with NND or RDS. There was one IUD in the study group, rest of the maternal and foetal outcomes studied were not statistically significant between two the groups. The caesarean section rates in both groups was not statistically different, however, there were more caesarean sections done for foetal distress in the study group, p=0.04.

Conclusions: Thyroid peroxidase positivity is present in 11.3% of euthyroid women and is associated with an increased risk of developing hypothyroidism during pregnancy. It is not associated with adverse foeto-maternal outcome.


Abbassi-Ghanavati M, Casey BM, Spong CY, McIntire DD, Halvorson LM, Cunningham FG. Pregnancy outcomes in women with thyroid peroxidase antibodies. Obstet Gynaecol. 2010;116(2):381-6.

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 Endocrinol Metab. 2006;91(7):2587-91.

Ghafoor F, Mansoor M, Malik T, Malik MS, KhanAU, Edwards R et al. Role of thyroid peroxidase antibodies in the outcome of pregnancy. J Coll Physicians Surg Pak. 2006;16(7):468-71.

Casey BM, Dashe JS, Spong CY, McIntire DD, Leveno KJ, Cunningham GF. Perinatal significance of isolated maternal hypothyroxinemia identified in the first half of pregnancy. Obstet Gynecol. 2007;109(5):1129-35.

Pop VJ, Brouwers EP, Vader HL, Vulsma T, van Baar AL, de Vijlder JJ. Maternal hypothyroxinaemia during early pregnancy and subsequent child development: a 3-year follow up study. Clin Endocrinol (oxf). 2003;59:282-8.

Thangaratinam S, Tan A, Knox E, Kilby MD, Franklyn J, Coomarasamy A. Association between thyroid autoantibodies and miscarriage and preterm birth:meta-analyses of evidence. BMJ. 2011;342:1-8.

Prummel MF, Wiersinga WM. Thyroid autoimmunity and miscarriage. Eur J Endocrinol. 2004;150(5):751-5.

Glinoer D. Editorial: Miscarriage in women with positive anti-TPO antibodies: Is thyroxine the answer. J Clin Endocrinol Metab. 2006;91(7):2500-2.

Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017;27(3):315-89.

Poppe K, Glinoer D. Thyroid autoimmunity and hypothyroidism before and during pregnancy. Hum Reprod Update. 2003;9(2):149-61.

Banerjee S. Thyroid disorders in pregnancy. J Assoc Physicians India 2011; 59(suppl):32-34.

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):1-46.

Marwaha RK, Chopra S, Gopalakrishnan S, Sharma B, Kanwar RS, Sastry A et al. Establishment of reference range for thyroid hormones in normal pregnant Indian women. BJOG 2008;115(5):602-06.

Iijima T, Tada H, Hidaka Y, Mitsuda N, Murata Y, Amino N. Effects of autoantibodies on the course of pregnancy and fetal growth. Obstet Gynecol 1997;90(3):364-69.

Haddow JE, Cleary-Goldman J, McClain MR, Palomaki GE, Neveux LM, Lambert-Messerlian G, et al. Thyroidperoxidase and thyroglobulin antibodies in early pregnancy and preterm delivery. Obstet Gynecol 2010;116(1):58-62.

Gayathri R, Lavanya S, Raghwan K. Subclinical hypothyroidism and autoimmune thyroiditis in pregnancy. J Assoc Physicians India 2009;57:691-3.

Glinoer D, Rihi M, Grün JP, Kinthaert J. Risk of subclinical hypothyroidism in pregnant women with asymptomatic autoimmune thyroid disorders. J Clin Endocrinol Metab. 1994;79(1):197-04.

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;94(3):772-9.

Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Thyroid antibody positivity in the first trimester of pregnancy is associated with negative pregnancy outcomes. J Clin Endocrinol Metab. 2011;96(6):E920-24.

Männistö T, Vääräsmäki M, Pouta A, Hartikainen AL, Ruokonen A, Surcel HM et al. Thyroid dysfunction and autoantibodies during pregnancy as predictive factors of pregnancy complications and maternal morbidity in later life. J Clin Endocrinol Metab. 2010;95(3):1084-94.

Stagnaro-Green A, Roman SH, Cobin RH, Harazy E, Alvarez-Marfany M, Davies TF. Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. JAMA. 1990;264(11):1422-7.

Stagnaro-Green A, Chen X, Bogden JD, Davies TF, Scholl TO. The thyroid and pregnancy: a novel risk factor for very preterm delivery. Thyroid. 2005;15(4):351-7.

He X, Wang P, Wang Z, He X, Xu D, Wang B. Thyroid antibodies and risk of preterm delivery: a meta-analysis of prospective cohort studies. Eur J Endocrinol. 2012;167(4):455-64.






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