Treat Subclinical Hypothyroidism in Pregnant Women: Study

The analyze included in this summary was printed on Study Square as a preprint and has not nonetheless been peer reviewed.

Important Takeaways

• Among expecting women of all ages with subclinical hypothyroidism (TSH > 3.74 mIU/L) who did not have thyroid peroxidase antibodies (TPOAb) and who did not obtain levothyroxine (LT4) remedy, the prevalence of gestational diabetes and preeclampsia was larger than among the expecting gals with typical thyroid (TSH ≤ 3.74 mIU/L) and no TPOAb (reference group) in a new research.

• Even so, amid pregnant women with subclinical hypothyroidism without having TPOAb who did get LT4 procedure, the prevalence of gestational diabetes and preeclampsia was similar to that amid women of all ages in the reference group.

• Beginning LT4 treatment method through the late to start with trimester to early next trimester was even now valuable with regard to maternal preeclampsia and gestational diabetes (which normally occur afterwards in being pregnant).

• The prevalence of iron-deficient anemia was lower in the LT4-taken care of team than in the reference team.

Why This Issues

• There is small proof on the result of subclinical hypothyroidism (TSH > 4. mIU/L) on pregnancy results, and the outcomes are conflicting.

• Couple of studies have been released relating to expecting women of all ages with subclinical hypothyroidism without the need of TPOAb, quite possibly mainly because TPOAb is the most frequent lead to of this thyroid dysfunction.

• This is the initial examine involving expecting girls with subclinical hypothyroidism and no TPOAb that displays a advantageous outcome of LT4 remedy on maternal being pregnant results of preeclampsia, gestational diabetic issues, and iron deficiency anemia.

• The success deliver assist for screening expecting females to decide their serum TSH amounts and for furnishing LT4 treatment to women of all ages with subclinical hypothyroidism (TSH from 4. – 10. mIU/L), no matter of their TPOAb standing.

Analyze Design and style

• The researchers carried out a cross-sectional analysis of details from 1460 expecting girls who experienced their initially antenatal consultation at a solitary centre in Brussels, Belgium, and have been screened for thyroid functionality (TSH, cost-free T4) and autoimmunity (TPOAb) at a median of 13 weeks’ gestation from January 2013 to December 2014.

• Gals were being excluded if they had sort 1 or form 2 diabetic issues or thyroid diseases in advance of their being pregnant of if they experienced twin or assisted being pregnant, TPO positivity, overt hypothyroidism, or remedy with LT4 prior to screening.

• The 71 girls who experienced subclinical hypothyroidism without the need of TPOAb were being divided into two teams: 53 girls experienced started off LT4 treatment at a median of 13 weeks (aiming to maintain TSH ranges <2.5 mIU/L), while the other 18 women did not receive this treatment.

• The remaining 1389 women with normal thyroid and no TPOAb were the reference group.

• The researchers compared rates of preeclampsia, gestational diabetes, iron deficiency anemia, blood loss at birth, emergency cesarean delivery, and preterm birth in the three groups.

Key Results

• The mean age of the women in the three groups was similar (roughly 29 years), as was the prevalence of obesity (roughly 20{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547}).

• Preeclampsia was more prevalent among women with subclinical hypothyroidism who did not receive LT4 compared to women in the reference group (16.7{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547} vs 5.0{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547} P = .017), but the rate was comparable in the LT4-treated subclinical hypothyroidism group compared with the reference group (7.6{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547} vs 5.0{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547} P = .918).

• The prevalence of gestational diabetes was higher among the women with subclinical hypothyroidism who did not receive LT4 compared to women in the reference group (27.8{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547} vs 18.9{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547} P = .016), but the rate was comparable in the LT4-treated subclinical hypothyroidism group compared with the reference group (22.6{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547} vs 18.9{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547} P = .676).

• The prevalence of iron deficiency anemia was lower among the LT4-treated women than in the reference group (17.0{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547} vs 32.5{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547} P = .017), and it was similar among the women with subclinical hypothyroidism who did not receive LT4 in comparison with the reference group (50{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547} vs 32.5{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547} P = .117).

• The rate of preterm birth was higher in the LT4-treated group than in the reference group (13.2{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547} vs 5{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547}) the rate was too low (0{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547}) among women with subclinical hypothyroidism who did not receive LT4 to perform a statistical analysis.

• Rates of blood loss at birth and emergency cesarean delivery were comparable in the three groups of women.

Limitations

• This was a retrospective analysis.

• There was no information about why women with subclinical hypothyroidism were not treated with LT4 (eg, treatment was refused or was not proposed by the physician).

• Thyroglobulin antibody (TgAb) levels were not available, so some women may have been misclassified as not having thyroid autoimmunity. (In a study of infertile women in the same geographic area, 5{a0ae49ae04129c4068d784f4a35ae39a7b56de88307d03cceed9a41caec42547} were found to be positive for TgAb and negative for TPOAb.)

• There was no documentation of previous gestational diabetes.

• Only women who underwent an oral glucose tolerance test were included in the gestational diabetes outcome, so some women with an increase in fasting glycemia during early pregnancy were excluded, which may have introduced bias.

Disclosures

This is a summary of a preprint research study, “Impact of Thyroid Hormone Treatment on Maternal Pregnancy Outcomes in Women With Subclinical Hypothyroidism Without TPOAb,” written by researchers from the Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium. Preprints from Research Square are provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on Research Square.

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