An observational study of fetomaternal outcome in euthyroid women with anti-thyroid peroxidase antibodies at tertiary care hospital


  • Harendra K. Netra Department of Obstetrics and Gynecology, SMS Medical College, Jaipur, Rajasthan, India
  • Reena Pant Department of Obstetrics and Gynecology, SMS Medical College, Jaipur, Rajasthan, India
  • Krishna P. Banerjee Department of Obstetrics and Gynecology, SMS Medical College, Jaipur, Rajasthan, India



Anti-thyroid peroxidase antibodies, Euthyroid, Pregnancy outcome


Background: Several changes are observed in maternal thyroid function during pregnancy and failure to adapt to these physiological changes results in thyroid dysfunction, especially if complicated by the presence of thyroid antibodies. The presence of TPO-Ab is associated with increased rate of pregnancy complications such as miscarriage, preterm delivery, placental abruption, pregnancy-induced hypertension, intrauterine death and low birth weight. Objective of this study was to study the effect of anti-TPO Ab positivity on pregnancy outcome and estimate the prevalence of anti-TPO Ab in euthyroid obstetric women.

Methods: This observational study enrolled 500 euthyroid pregnant women, age 20-35 years, up to 20 weeks gestation. Venous blood samples collected and analyzed for the anti TPO Ab levels. On the basis of anti TPO Ab positivity they were divided into two groups, anti-TPO Ab positive and Ab negative group. These two groups were followed up till delivery or abortion and compared for maternal and fetal outcomes.

Results: Prevalence of anti-TPO antibody positivity was 5.2% in euthyroid obstetric women. Most of anti-TPO Ab positive women were overweight. There were higher numbers of miscarriage (11.54%) in anti-TPO Ab positive euthyroid pregnancies than (2.53%) in antibody negative women. Incidence of low birth weight babies was 4-fold higher in anti-TPO Ab positive women. More than two-fold increase in incidence of placental abruption in anti-TPO Ab positive women. Parity, anaemia, gestational hypertension, preeclampsia, GDM, PROM, PPH, low Apgar scores, NICU admission, IUD and neonatal death were not significantly associated with anti-TPO Ab positivity.

Conclusions: Anti TPO Ab positivity significantly associated with pre-pregnancy BMI, miscarriage rates and low birth weight of newborns.



Glinoer D, Riahi M, Grun JP, Kinthaert J. Risk of subclinical hypothyroidism in pregnant women with asymptomatic autoimmune thyroid disorders. J Clin Endocrinol Metab. 1994;79:197-204.

Glinoer D. The thyroid function during pregnancy: maternal and neonatal aspects. In: The Thyroid and Pregnancy. Beckers C, Reinwein D (Eds). Schattauer, NY, USA; 1991:35-43.

Korevaar TIM, Pop VJ, Chaker L, Goddijn M, Rijke YB, Bisschop PH, et al. Dose dependency and a functional cutoff for TPO-antibody positivity during pregnancy. J Clin Endocrinol Metab. 2018;103(2):778-9.

Karakosta P, Alegakis D, Georgiou V, Roumeliotaki T, Fthenou E, Vassilaki M, et al. Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes. J Clin Endocrinol Metab. 2012;97:4464-72.

Gayathri R, Lavanya S, Raghavan. Subclinical hypothyroidism and autoimmune thyroiditis in pregnancy- a study in south Indian subjects. JAPI. 2009;57:691-3.

Meena A, Nagar P. Pregnancy outcome in euthyroid women with anti-thyroid peroxidase antibodies. J Obstet Gynaecol India. 2016;66(3):160-5.

Meena M, Chopra S, Jain V, Aggarwal N. The effect of anti-thyroid peroxidase antibodies on pregnancy outcomes in euthyroid women. J Clin Diagn Res. 2016;10(9):QC04-7.

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.

Karuna, Das V, Agrawal S, Agarwal A, Pandey A, Mahdi AA. Status of thyroid peroxidase antibodies in pregnant women and association with obstetric and perinatal outcomes in tertiary care center. Nat J Laboratory Med. 2017;6(4):BO17-BO21.

Rajput R, Yadav T, Seth S, Nanda S. Prevalence of thyroid peroxidase antibody and pregnancy outcome in euthyroid autoimmune positive pregnant women from a tertiary care center in Haryana. Indian J Endocrinol Metab. 2017;21(4):577-80.

Masoomeh M, Ahia KA, Jamali M, Ebrahimi A, Mahya V. Effect of antithyroid peroxidase antibody on pregnancy outcome in euthyroid women. Perinatol. 2019;20(1):10-5.

Abbassi-Ghanavati M, Casey BM, Spong CY, McIntire DD, Halvorson LM, Cunningham FG. Pregnancy outcomes in women with thyroid peroxidase antibodies. Obstet Gynecol. 2010;116(2 Pt 1):381-6.

Stagnaro-Green A, Roman SH, Cobin RH, El-Harazy E, Alvarez-Marfany E, Davies TF. Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. J Am Med Associat. 1990;264(11):1422-5.

Mannisto T, Vaarasmaki M, Pouta A, Suvanto E. 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, Chen X, Bogden JD, Scholl TO. The thyroid and pregnancy: a novel risk factor for very preterm delivery. Thyroid. 2005;15:351-7.

Tierney K, Delpachitra P, Grossmann M, Onwude J, Tong S. Thyroid function and autoantibody status among women who spontaneously delivery under 35 weeks of gestation. Clin Endocrinol (Oxf). 2009;71:892-5.

Negro R, Schwartz A, Gismondi R, Tinelli A, 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):E920-4.






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