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Congenital hypothyroidism linked to adverse pregnancy outcomes
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Adverse pregnancy outcomes may be linked to congenital hypothyroidism, according to recent study findings published in The Journal of Clinical Endocrinology and Metabolism.
“Adverse outcomes were probably due to inadequate treatment as, despite the lower precision due to the smaller sample size, women in whom adequate control of hypothyroidism was achieved early and maintained during pregnancy were more likely to have a favorable pregnancy outcome, with a higher risk only for induced labor for vaginal delivery,” the researchers wrote.
Juliane Léger, MD, of the Hôpital Robert Debré in Paris, and colleagues conducted a longitudinal population-based study of women with congenital hypothyroidism to determine its effect on pregnancy outcomes. Based on a questionnaire about fecundity, researchers identified all singleton pregnancies after more than 22 weeks of gestation, with newborns weighing at least 500 g, that ended before the survey (retrospective group; n=207) and in the 3 years after the survey (prospective group; n=174). Researchers also evaluated a reference group (n=7,425) of women without congenital hypothyroidism for comparison.
Among the prospective group only, increased risks for gestational hypertension, emergency cesarean section, induced labor for vaginal delivery and preterm birth were all associated with congenital hypothyroidism. A higher risk for hemorrhage during the second and/or third trimester of gestation was associated with congenital hypothyroidism among all groups. Researchers also observed a higher risk for at least one or two adverse pregnancy outcomes among participants with congenital hypothyroidism compared with the reference group. An increased risk for premature delivery was associated with clinical hypothyroidism in early adulthood (adjusted OR=3.9; 95% CI, 1.4-11.3).
Higher risks for preterm delivery during the first trimester (aOR=5.6; 95% CI, 1.6-20) and fetal macrosomia during the first or second trimester (aOR=4.5; 95% CI, 1.03-20.1) were associated with thyroid-stimulating hormone concentrations of at least 10 mIU/L.
“Despite the small number of subjects included in the analysis, our results suggest that the adequate management of hypothyroidism decreases the risk of adverse pregnancy outcomes,” the researchers wrote. “These novel findings for patients with [congenital hypothyroidism] highlight the need for more appropriate thyroid disease management, particularly during the first two trimesters of pregnancy, and for vigilant monitoring and adherence to treatment, to decrease the impact of the disease on both mother and child. Future prospective studies focusing on active management to prevent treatment inadequacy during pregnancy should highlight the potential benefits of such management in terms of maternal and fetal outcomes.”
Disclosure: The study was funded in part by the French Ministry of Health and the Pfizer Foundation for Children and Adolescents.
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