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Endokrine Ursachen von Aborten

Schilddrüsenfehlfunktion, polyzystisches Ovarsyndrom und Adipositas

Endocrinal dysfunctions as causes of abortion

Thyroid dysfunction, polycystic ovary syndrome, and obesity

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Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Hintergrund

Endokrine Erkrankungen wie Hypothyreose, polyzystisches Ovarsyndrom und Übergewicht können das Risiko für Fehlgeburten erhöhen.

Diagnose und Therapie

Die frühzeitige Diagnose und Behandlung dieser Störungen bereits vor der Konzeption scheinen mit einem günstigen Effekt auf den Schwangerschaftsverlauf einherzugehen.

Diese Arbeit fasst die verfügbare Evidenz für eine ursächliche Beziehung zwischen endokrinen Störungen und Fehlgeburten zusammen und leitet daraus praktische Vorschläge für therapeutische Strategien ab.

Abstract

Background

Endocrine dysfunctions such as hypothyreoidism, polycystic ovary syndrome (PCOS) and obesity are associated with an increased risk for abortions.

Diagnosis and treatment

In these conditions, early diagnosis and treatment prior to conception appears to have a beneficial effect on pregnancy outcome.

Conclusion

The available evidence for a causal relationship of endocrine dysfunctions with abortions is presented and practical therapeutic strategies are suggested.

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Literatur

  1. Poppe K, Velkeniers B, Glinoer D (2007) Thyroid disease and female reproduction. Clin Endocrinol (Oxf) 66:309–321

    Google Scholar 

  2. Stagnaro-Green A, Roman SH, Cobin RH et al (1990) Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. JAMA 264:1422–1425

    Article  PubMed  CAS  Google Scholar 

  3. Kaprara A, Krassas GE (2008) Thyroid autoimmunity and miscarriage. Hormones (Athens) 7:294–302

  4. Matalon ST, Blank M, Ornoy A et al (2001) The association between anti-thyroid antibodies and pregnancy loss. Am J Reprod Immunol 45:72–77

    Article  PubMed  CAS  Google Scholar 

  5. Vaquero E, Lazzarin N, De Carolis C et al (2000) Mild thyroid abnormalities and recurrent spontaneous abortion: diagnostic and therapeutical approach. Am J Reprod Immunol 43:204–208

    Article  PubMed  CAS  Google Scholar 

  6. Krassas GE, Poppe K, Glinoer D (2010) Thyroid function and human reproductive health. Endocr Rev 31:702–755

    Article  PubMed  CAS  Google Scholar 

  7. Benhadi N, Wiersinga WM, Reitsma JB et al (2009) Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death. Eur J Endocrinol 160:985–991

    Article  PubMed  CAS  Google Scholar 

  8. Negro R, Schwartz A, Gismondi R et al (2010) Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy. J Clin Endocrinol Metab 95:E44–E48

    Google Scholar 

  9. De Vivo A, Mancuso A, Giacobbe A et al (2010) Thyroid function in women found to have early pregnancy loss. Thyroid 20:633–637

    Article  Google Scholar 

  10. Abalovich M, Gutierrez S, Alcaraz G et al (2002) Overt and subclinical hypothyroidism complicating pregnancy. Thyroid 12:63–68

    Article  PubMed  CAS  Google Scholar 

  11. Bussen S, Steck T, Dietl J (2000) Increased prevalence of thyroid antibodies in euthyroid women with a history of recurrent in-vitro fertilization failure. Hum Reprod 15:545–548

    Article  PubMed  CAS  Google Scholar 

  12. Negro R, Formoso G, Mangieri T et al (2006) Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab 91:2587–2591

    Google Scholar 

  13. Reid SM, Middleton P, Cossich MC et al (2010) Interventions for clinical and subclinical hypothyroidism in pregnancy. Cochrane Database Syst Rev 7:CD007752

    PubMed  Google Scholar 

  14. Alexander EK, Marqusee E, Lawrence J et al (2004) Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. N Engl J Med 351:241–249

    Google Scholar 

  15. Glinoer D (2009) Thyroidal and immune adaptation to pregnancy: focus on maternal hypo- and hyperthyroidism. In: Lazarus J, Pirags V, Butz S (Hrsg) The thyroid and reproduction. Thieme, New York/NY, S 46–58

  16. Glinoer D (2000) Thyroid immunity, thyroid dysfunction, and the risk of miscarriage: à propos article by Vaquero et al. Mild thyroid abnormalities and recurrent spontaneous abortion: diagnostic and therapeutical approach. Am J Reprod Immunol 43:202–203

    Article  PubMed  CAS  Google Scholar 

  17. Glinoer D, Delange F (2000) The potential repercussions of maternal, fetal, and neonatal hypothyroxinemia on the progeny. Thyroid 10:871–887

    Article  PubMed  CAS  Google Scholar 

  18. Vissenberg R, Boogaard E van den, Wely M van et al (2012) Treatment of thyroid disorders before conception and in early pregnancy: a systematic review. Hum Reprod Update 18:360–373

    Article  PubMed  CAS  Google Scholar 

  19. Glueck CJ, Wang P, Goldenberg N et al (2002) Pregnancy outcomes among women with polycystic ovary syndrome treated with metformin. Hum Reprod 17:2858–2864

    Article  PubMed  CAS  Google Scholar 

  20. Cocksedge KA, Li TC, Saravelos SH et al (2008) A reappraisal of the role of polycystic ovary syndrome in recurrent miscarriage. Reprod Biomed Online 17:151–160

    Article  PubMed  Google Scholar 

  21. Craig LB, Ke RW, Kutteh WH (2002) Increased prevalence of insulin resistance in women with a history of recurrent pregnancy loss. Fertil Steril 78:487–490

    Article  PubMed  Google Scholar 

  22. Glueck CJ, Phillips H, Cameron D et al (2001) Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester spontaneous abortion: a pilot study. Fertil Steril 75:46–52

    Article  PubMed  CAS  Google Scholar 

  23. Jakubowicz DJ, Iuorno MJ, Jakubowicz S et al (2002) Effects of metformin on early pregnancy loss in the polycystic ovary syndrome. J Clin Endocrinol Metab 87:524–529

    Google Scholar 

  24. Sills ES, Perloe M, Palermo GD (2000) Correction of hyperinsulinemia in oligoovulatory women with clomiphene-resistant polycystic ovary syndrome: a review of therapeutic rationale and reproductive outcomes. Eur J Obstet Gynecol Reprod Biol 91:135–141

    Article  PubMed  CAS  Google Scholar 

  25. Zolghadri J, Tavana Z, Kazerooni T et al (2008) Relationship between abnormal glucose tolerance test and history of previous recurrent miscarriages, and beneficial effect of metformin in these patients: a prospective clinical study. Fertil Steril 90:727–730

    Article  PubMed  Google Scholar 

  26. Legro RS, Barnhart HX, Schlaff WD et al; Cooperative Multicenter Reproductive Medicine Network (2007) Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Engl J Med 356:551–566

    Google Scholar 

  27. Moll E, Bossuyt PM, Korevaar JC et al (2006) Effect of clomifene citrate plus metformin and clomifene citrate plus placebo on induction of ovulation in women with newly diagnosed polycystic ovary syndrome: randomised double blind clinical trial. BMJ 332:1485

    Article  PubMed  CAS  Google Scholar 

  28. Palomba S, Orio F Jr, Falbo A et al (2005) Plasminogen activator inhibitor 1 and miscarriage after metformin treatment and laparoscopic ovarian drilling in patients with polycystic ovary syndrome. Fertil Steril 84:761–765

    Article  PubMed  CAS  Google Scholar 

  29. Glueck CJ, Wang P, Fontaine RN et al (1999) Plasminogen activator inhibitor activity: an independent risk factor for the high miscarriage rate during pregnancy in women with polycystic ovary syndrome. Metabolism 48:1589–1595

    Article  PubMed  CAS  Google Scholar 

  30. Glueck CJ, Goldenberg N, Pranikoff J et al (2004) Height, weight, and motor-social development during the first 18 months of life in 126 infants born to 109 mothers with polycystic ovary syndrome who conceived on and continued metformin through pregnancy. Hum Reprod 19:1323–1330

    Article  PubMed  CAS  Google Scholar 

  31. Schuring AN, Schulte N, Sonntag B et al (2008) Androgens and insulin—two key players in polycystic ovary syndrome. Recent concepts in the pathophysiology and genetics of polycystic ovary syndrome. Gynakol Geburtshilfliche Rundsch 48:9–15

    Article  PubMed  Google Scholar 

  32. Liddell HS, Sowden K, Farquhar CM (1997) Recurrent miscarriage: screening for polycystic ovaries and subsequent pregnancy outcome. Aust N Z J Obstet Gynaecol 37:402–406

    Google Scholar 

  33. Rai R, Backos M, Rushworth F et al (2000) Polycystic ovaries and recurrent miscarriage – a reappraisal. Hum Reprod 15:612–615

    Article  PubMed  CAS  Google Scholar 

  34. Okon MA, Laird SM, Tuckerman EM et al (1998) Serum androgen levels in women who have recurrent miscarriages and their correlation with markers of endometrial function. Fertil Steril 69:682–690

    Article  PubMed  CAS  Google Scholar 

  35. Wely M van, Bayram N, Veen F van der et al (2005) Predicting ongoing pregnancy following ovulation induction with recombinant FSH in women with polycystic ovary syndrome. Hum Reprod 20:1827–1832

    Article  PubMed  Google Scholar 

  36. Metwally M, Ong KJ, Ledger WL et al (2008) Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis of the evidence. Fertil Steril 90:714–726

    Article  PubMed  Google Scholar 

  37. Lashen H, Fear K, Sturdee DW (2004) Obesity is associated with increased risk of first trimester and recurrent miscarriage: matched case-control study. Hum Reprod 19:1644–1646

    Article  PubMed  CAS  Google Scholar 

  38. Al-Azemi M, Omu FE, Omu AE et al (2004) The effect of obesity on the outcome of infertility management in women with polycystic ovary syndrome. Arch Gynecol Obstet 270:205–210

    Article  PubMed  Google Scholar 

  39. Hamilton-Fairley D, Kiddy D, Watson H et al (1992) Association of moderate obesity with a poor pregnancy outcome in women with polycystic ovary syndrome treated with low dose gonadotrophin. Br J Obstet Gynaecol 99:128–131

    Article  PubMed  CAS  Google Scholar 

  40. Clark AM, Ledger W, Galletly C et al (1995) Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Hum Reprod 10:2705–2712

    Article  PubMed  CAS  Google Scholar 

  41. Boots C, Stephenson MD (2011) Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review. Semin Reprod Med 29:507–513

    Article  PubMed  Google Scholar 

  42. Metwally M, Saravelos SH, Ledger WL (2010) Body mass index and risk of miscarriage in women with recurrent miscarriage. Fertil Steril 94:290–295

    Article  PubMed  Google Scholar 

  43. Maconochie N, Doyle P, Prior S et al (2007) Risk factors for first trimester miscarriage – results from a UK-population-based case-control study. BJOG 114:170–186

    Article  PubMed  CAS  Google Scholar 

  44. Hill A, Roberts J (1998) Body mass index: a comparison between self-reported and measured height and weight. J Public Health Med 20:206–210

    Google Scholar 

  45. Spencer EA, Appleby PN, Davey GK et al (2002) Validity of self-reported height and weight in 4808 EPIC-Oxford participants. Public Health Nutr 5:561–565

    Article  PubMed  Google Scholar 

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Schüring, A., Schmedt, A. & Kiesel, L. Endokrine Ursachen von Aborten. Gynäkologische Endokrinologie 11, 104–108 (2013). https://doi.org/10.1007/s10304-012-0520-8

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  • DOI: https://doi.org/10.1007/s10304-012-0520-8

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