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A first-trimester serum TSH in the 4–10 mIU/L range is associated with obstetric complications in thyroid peroxidase antibody-negative women

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Abstract

Purpose

The impact of mild subclinical hypothyroidism on pregnancy outcomes in TPOAb-negative women is poorly explored. The aim of the present study was the evaluation in a wide cohort of TPOAb-negative pregnant women the role of subclinical hypothyroidism (SCH) on several pregnancy outcomes.

Methods

The study included women aged ≥ 18 years with a singleton pregnancy without known thyroid disease with serum TSH concentration between 0.4 and 10 mIU/L and TPOAb negative. Data about clinical and demographic features were collected. A blood sample was drown to test TSH, TPOAb, ANA and ENA concentration. The mean uterine artery pulsatility index was measured. Risk of adverse obstetric and fetal outcomes was collected.

Results

The cohort included 2135 pregnant women. Pregnant women with TSH 4–10 mUI/L had a significantly higher frequency of family history of thyroid diseases, and personal history of celiac disease diseases, type 1 diabetes mellitus, rheumatic disease, antinuclear antibody (ANA) and anti-extractable nuclear antigen (ENA) positive tests. The risk for pre-eclampsia and small for gestational age (SGA) was significantly higher in pregnant women with first-trimester TSH 4–10 mIU/L. A first-trimester TSH serum level greater than 4 mIU/L was associated with a significant increase in the occurrence of abnormal uterine artery pulsatility index, with a more than threefold increase in the risk of developing pre-eclampsia and with the risk of SGA.

Conclusions

In TPOAb-negative pregnant women, a first-trimester serum TSH level ranging from 4 to 10 mIU/L is significantly and independently linked to an increased uterine artery pulsatility index as well as to negative pregnancy outcomes such as pre-eclampsia, SGA and gestational diabetes.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Unit of Internal Medicine and Endocrinology, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, via Maugeri 10, 27100, Pavia, Italy

    F. Magri, L. Croce, M. Rotondi & L. Chiovato

  2. Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, University of Pavia, Pavia, Italy

    C. Bellingeri, I. De Maggio, A. Spinillo & F. Beneventi

  3. Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy

    F. Coperchini

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Flavia Magri, Laura Croce, Luca Chiovato and Mario Rotondi are members of the Editorial Board of Journal of Endocrinological Investigation. On behalf of the other authors, the corresponding author states that there is no conflict of interest.

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Magri, F., Bellingeri, C., De Maggio, I. et al. A first-trimester serum TSH in the 4–10 mIU/L range is associated with obstetric complications in thyroid peroxidase antibody-negative women. J Endocrinol Invest 46, 1407–1414 (2023). https://doi.org/10.1007/s40618-022-01996-z

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