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Thyroid Autoimmunity and Pregnancy

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Thyroid Disease in Pregnancy - A Guide to Clinical Management

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Abstract

Thyroid autoimmunity (TAI) during pregnancy remains a challenge in management. Anti-thyroid peroxidase antibodies and anti-thyroglobulin antibodies are most commonly associated with TAI. Published evidence show the prevalence of TAI in pregnant women to be between 2 and 17% globally and 10 and 19% in India. There is increasing evidence to suggest that TAI is associated with adverse pregnancy outcomes like pregnancy loss, premature birth, gestational diabetes, post-partum thyroiditis, post-natal depression and some adverse foetal outcomes like sensorineural hearing loss and attention deficit hyperactivity syndrome. TAI is also associated with progressive maternal thyroid dysfunction during pregnancy. The mechanisms on etiopathogenesis of TAI and the various pregnancy complications are not completely clear. Putative hypotheses include a generalised autoimmune phenomenon with a hostile uterine microenvironment, a decreased thyroid hormone reserve secondary to TAI or a direct pathogenicity of the TAI to the developing embryo. Despite the compelling evidence on association between TAI and pregnancy complications, the evidence of the effect of treatment of TAI during pregnancy has been mixed and largely disappointing. The various treatment modalities studied include thyroxine, selenium, oral steroids and intravenous immunoglobulins. Nevertheless, monitoring pregnant women with TAI for the development of thyroid dysfunction during pregnancy and treating those with overt thyroid hypofunction remains important.

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Authors and Affiliations

  1. All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

    Kalyani Sridharan

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  1. Kalyani Sridharan
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Editors and Affiliations

  1. Dept. of Obstetrics and Gynaecology, JIPMER, Puducherry, India

    Haritha Sagili

  2. Dept. of Endocrinology, JIPMER, Puducherry, India

    Jayaprakash Sahoo

  3. Dept. of Obstetrics and Gynaecology, Sri Venkateswaraa Medical College Hospital and Research Centre, Puducherry, India

    Swaramya Chandrasekaran

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Sridharan, K. (2023). Thyroid Autoimmunity and Pregnancy. In: Sagili, H., Sahoo, J., Chandrasekaran, S. (eds) Thyroid Disease in Pregnancy - A Guide to Clinical Management. Springer, Singapore. https://doi.org/10.1007/978-981-99-5423-0_4

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  • DOI: https://doi.org/10.1007/978-981-99-5423-0_4

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