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High prevalence of thyroid dysfunction in pregnant women

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Abstract

Background/Aim: Maternal thyroid dysfunction during pregnancy has been associated with adverse obstetric and neonatal outcomes. This prospective study evaluates the prevalence of these disorders in pregnant women. Subjects and methods: Serum levels of TSH, free T4 (fT4), and thyroperoxidase antibodies (TPO-Ab) were measured in 951 women at different gestational ages of pregnancy. Trimester-specific reference ranges for TSH were used to classify pregnant women into five groups: 1) Overt hypothyroidism (OH); 2) Subclinical hypothyroidism (SCH); 3) Isolated hypothyroxinemia (IH); 4) Low TSH (isolated or associated with high fT4); and 5) Normal. A classification was made also according to the lower and upper ranges provided by the manufacturer for thyroid hormones. Pregnant women who were at a high risk of developing thyroid disease were identified. Results: Altogether, 117 women (12.3%) had hypothyroidism and 25 (2.6%) had low TSH. The prevalence of both OH and SCH was higher in the high-risk group than in the low-risk group, but 17.9% of women with hypothyroidism were classified at low-risk. A family history of thyroid disorders and TPO-Ab positivity increased the risk of SCH. Using non-pregnant reference range for TSH, 10.6% of women were misclassificated. Conclusions: The high prevalence of hypothyroidism observed in this study suggests that accurate thyroid screening with trimester specific reference ranges should be warranted, particularly in areas with mild to moderate iodine deficiencies.

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References

  1. Klein RZ, Haddow JE, Faix JD, et al. Prevalence of thyroid deficiency in pregnant women. Clin Endocrinol (Oxf) 1991, 35: 41–6.

    Article  CAS  Google Scholar 

  2. Abalovich M, Gutierrez S, Alcaraz G, Maccallini G, Garcia A, Levalle O. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid 2002, 12: 63–8.

    Article  CAS  PubMed  Google Scholar 

  3. Lazarus JH, Premawardhana LD. Screening for thyroid disease in pregnancy. J Clin Pathol 2005, 58: 449–52.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Glinoer D. The systematic screening and management of hypothyroidism and hyperthyroidism during pregnancy. Trends Endocrinol Metab 1998, 9: 403–11.

    Article  CAS  PubMed  Google Scholar 

  5. Allan WC, Haddow JE, Palomaki GE, et al. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen 2000, 7: 127–30.

    Article  CAS  PubMed  Google Scholar 

  6. Casey BM, Dashe JS, Wells CE, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol 2005, 105: 239–45.

    Article  PubMed  Google Scholar 

  7. Caturegli P, Newschaffer C, Olivi A, Pomper MG, Burger PC, Rose NR. Autoimmune hypophysitis. Endocr Rev 2005, 26: 599–614.

    Article  CAS  PubMed  Google Scholar 

  8. Haddow JE, Palomaki GE, Allan WC, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999, 341: 549–55.

    Article  CAS  PubMed  Google Scholar 

  9. Pop VJ, Vulsma T. Maternal hypothyroxinaemia during (early) gestation. Lancet 2005, 365: 1604–6.

    Article  PubMed  Google Scholar 

  10. Vermiglio F, Lo Presti VP, Moleti M, et al. Attention deficit and hyperactivity disorders in the offspring of mothers exposed to mild-moderate iodine deficiency: a possible novel iodine deficiency disorder in developed countries. J Clin Endocrinol Metab 2004, 89: 6054–60.

    Article  CAS  PubMed  Google Scholar 

  11. Abalovich M, Amino N, Barbour LA, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2007, 92: S1–47.

    Article  CAS  PubMed  Google Scholar 

  12. Stagnaro-Green A, Abalovich M, Alexander E, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011, 21: 1081–125.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Lazarus JH, Bestwick JP, Channon S, et al. Antenatal thyroid screening and childhood cognitive function. N Engl J Med 2012, 366: 493–501.

    Article  CAS  PubMed  Google Scholar 

  14. Vissenberg R, van den Boogaard E, van Wely M, et al. Treatment of thyroid disorders before conception and in early pregnancy: a systematic review. Hum Reprod Update 2012, 18: 360–73.

    Article  CAS  PubMed  Google Scholar 

  15. Momotani N, Iwama S, Momotani K. Neurodevelopment in children born to hypothyroid mothers restored to normal thyroxine (t4) concentration by late pregnancy in Japan: no apparent influence of maternal t4 deficiency. J Clin Endocrinol Metab 2012, 97: 1104–8.

    Article  CAS  PubMed  Google Scholar 

  16. Vaidya B, Anthony S, Bilous M, et al. Detection of thyroid dysfunction in early pregnancy: Universal screening or targeted high-risk case finding? J Clin Endocrinol Metab 2007, 92: 203–7.

    Article  CAS  PubMed  Google Scholar 

  17. Horacek J, Spitalnikova S, Diabalova B, et al. Universal screening detects two times more thyroid disorders in early pregnancy than targeted high-risk case finding. Eur J Endocrinol 2010, 163: 645–50.

    Article  CAS  PubMed  Google Scholar 

  18. Chang DL, Leung AM, Braverman LE, Pearce EN. Thyroid testing during pregnancy at an academic Boston area medical center. J Clin Endocrinol Metab 2011, 96: 1452–6.

    Article  Google Scholar 

  19. Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Universal Screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab 2010, 95: 1699–707.

    Article  CAS  PubMed  Google Scholar 

  20. LeBeau SO, Mandel SJ. Thyroid disorders during pregnancy. Endocrinol Metab Clin North Am 2006, 35: 117–36.

    Article  PubMed  Google Scholar 

  21. Panesar NS, Li CY, Rogers MS. Reference intervals for thyroid hormones in pregnant Chinese women. Ann Clin Biochem 2001, 38: 329–32.

    Article  CAS  PubMed  Google Scholar 

  22. Dashe JS, Casey BM, Wells CE, et al. Thyroid-stimulating hormone in singleton and twin pregnancy: importance of gestational age-specific reference ranges. Obstet Gynecol 2005, 106: 753–7.

    Article  CAS  PubMed  Google Scholar 

  23. Sapin R, D’Herbomez M, Schlienger JL. Free thyroxine measured with equilibrium dialysis and nine immunoassays decreases in late pregnancy. Clin Lab 2004, 50: 581–4.

    CAS  PubMed  Google Scholar 

  24. Baloch Z, Carayon P, Conte-Devolx B, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003, 13: 3–126.

    Article  PubMed  Google Scholar 

  25. Mandel SJ, Spencer CA, Hollowell JG. Are detection and treatment of thyroid insufficiency in pregnancy feasible? Thyroid 2005, 15: 44–53.

    Article  PubMed  Google Scholar 

  26. Stricker R, Echenard M, Eberhart R, et al. Evaluation of maternal thyroid function during pregnancy: the importance of using gestational age-specific reference intervals. Eur J Endocrinol 2007, 157: 509–14.

    Article  CAS  PubMed  Google Scholar 

  27. Männistö T, Vääräsmäki M, Pouta A, 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: 1084–94.

    Article  PubMed  Google Scholar 

  28. 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: 1129–35.

    Article  PubMed  Google Scholar 

  29. Moleti M, Lo Presti VP, Campolo MC, et al. Iodine prophylaxis using iodized salt and risk of maternal thyroid failure in conditions of mild iodine deficiency. J Clin Endocrinol Metab 2008, 93: 2616–21.

    Article  CAS  PubMed  Google Scholar 

  30. Vermiglio F, Lo Presti VP, Castagna MG, et al. Increased risk of maternal thyroid failure with pregnancy progression in an iodine deficient area with major iodine deficiency disorders. Thyroid 1999, 9: 19–24.

    Article  CAS  PubMed  Google Scholar 

  31. Kibirige MS, Hutchison S, Owen CJ, Delves HT. Prevalence of maternal dietary iodine insufficiency in the north east of England: implications for the fetus. Arch Dis Child Fetal Neonatal Ed 2004, 89: F436–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Montoro M, Collea JV, Frasier D, Mestman JH. Successful outcome of pregnancy in women with hypothyroidism. Ann Intern Med 1981, 94: 31–4.

    Article  CAS  PubMed  Google Scholar 

  33. Davis LE, Leveno KJ, Cunningham FG. Hypothyroidism complicating pregnancy. Obstet Gynecol 1988, 72: 108–12.

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  35. Leung AS, Millar LK, Koonings PP, Montoro M, Mestman JH. Perinatal outcome in hypothyroid pregnancies. Obstet Gynecol 1993, 81: 349–53.

    CAS  PubMed  Google Scholar 

  36. 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: 351–7.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Section of Endocrinology, Andrology and Internal Medicine and Master in Andrological, Human Reproduction and Cellular Physiopathology, Department of Medical and Paediatric Sciences, University of Catania, Policlinico “G. Rodolico”, Via S. Sofia 78, Bldg 4, Room 2/104, 95123, Catania, Italy

    M. Altomare MD, S. La Vignera, P. Asero, D. Recupero, R. A. Condorelli, D. Tumino, S. Tumino, E. Vicari, R. D’Agata & A. E. Calogero

  2. Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania, Italy

    P. Scollo

  3. Prenatal Diagnosis Operative Unit, University of Catania, Catania, Italy

    A. Gulisano

  4. Clinical Biochemistry “G. Rodolico” Hospital, University of Catania, Catania, Italy

    E. Magro

  5. Department of Obstetrics and Gynaecology, University of Catania, Catania, Italy

    V. Leanza

Authors
  1. M. Altomare MD
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  2. S. La Vignera
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  3. P. Asero
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  4. D. Recupero
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  5. R. A. Condorelli
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  6. P. Scollo
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  7. A. Gulisano
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  8. E. Magro
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  9. D. Tumino
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  10. S. Tumino
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  12. V. Leanza
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  13. R. D’Agata
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  14. A. E. Calogero
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Corresponding author

Correspondence to M. Altomare MD.

Additional information

M.A., S.L.V. and P.A.equally contributed to the study.

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Altomare, M., La Vignera, S., Asero, P. et al. High prevalence of thyroid dysfunction in pregnant women. J Endocrinol Invest 36, 407–411 (2013). https://doi.org/10.3275/8658

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  • DOI: https://doi.org/10.3275/8658

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