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Thyroid autoimmunity and future pregnancy outcome in women of recurrent pregnancy loss: a meta-analysis

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Abstract

Background

Thyroid autoimmunity (TAI) has been associated with the risk of recurrent pregnancy loss (RPL). This systematic review and meta-analysis was conducted to evaluate the influence of TAI on subsequent pregnancy outcome of women with RPL.

Methods

A systematic search of Medline, Web of Science, and Embase was conducted to identify studies evaluating the influence of TAI on subsequent risk of pregnancy loss (PL) in women with RPL. Study quality was evaluated via the Newcastle–Ottawa Scale. A random-effects model was utilized to pool the results, accounting for heterogeneity.

Results

Ten observational studies were included. Compared to women without thyroid autoantibodies, RPL women with TAI had a higher risk of PL in their subsequent pregnancy (risk ratio [RR]: 1.46. 95% confidence interval [CI]: 1.20 to 1.78, p < 0.001; I2 = 35%). Sensitivity analyses showed consistent results in studies with thyroid peroxidase antibody positivity (RR: 1.50, 95% CI: 1.23 to 1.82) and in studies with TAI assessed before pregnancy (RR: 1.28, 95% CI: 1.07 to 1.53). Subgroup analyses showed that the results were not significantly different in prospective and retrospective studies, in RPL defined as at least two or three PL, in euthyroid women and women with euthyroidism or subclinical hypothyroidism, in women with and without levothyroxine treatment, in studies reporting first-trimester or overall PL, and in studies with different quality scores (p for subgroup difference all > 0.05).

Conclusions

In women with RPL, positive for TAI may be related to a higher risk of PL in subsequent pregnancy.

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Data availability

All data generated or analyzed during this study are included in this article.

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Funding

This work was supported by the Top Young Medical Talents of Hubei Province, the Outstanding Young and Middle-aged Science and Technology Innovation Team of Universities Foundation of Hubei Province (T2021020), and the Health Commission Foundation of Hubei Province (WJ2023M157).

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Authors and Affiliations

  1. Department of Reproductive Center, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Hubei Province, No. 136, Jingzhou Street, Xiangcheng District, Xiangyang City, 441021, China

    Xiaozhen Quan, Yanli Lan & Xuezhou Yang

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  1. Xiaozhen Quan
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Contributions

XQ and XY designed the study. XQ and YL performed literature search, study identification, quality valuation, data collection, and statistical analysis. XQ and XY interpreted the results. XQ drafted the manuscript. All authors revised the manuscript and approved the submission.

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Correspondence to Xuezhou Yang.

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Xiaozhen Quan and Yanli Lan contributed equally to this work.

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Quan, X., Lan, Y. & Yang, X. Thyroid autoimmunity and future pregnancy outcome in women of recurrent pregnancy loss: a meta-analysis. J Assist Reprod Genet 40, 2523–2537 (2023). https://doi.org/10.1007/s10815-023-02933-6

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