Thyroid dysfunction prevalence in high-risk pregnant women and maternal and neonatal consequences after delivery: A retrospective cohort study

Abstract

Objective: To evaluate thyroid dysfunction prevalence and its consequences in high-risk pregnant women and their children. Methods: In this retrospective cohort study, data from high-risk pregnant women who were referred to a governmental referral hospital in Qom, Iran from March to August 2022 were collected. The thyroid disorders were determined according to the 2017 American Thyroid Association guidelines. The predictors of a mother's hypothyroidism and its fetal and maternal consequences were assessed. Independent t-test, Chi-square test, and logistic regression were used for bivariate and multivariate analysis. Results: 293 women were included. The prevalence of hypothyroidism and hyperthyroidism based on the thyroid stimulating hormone classification was 32.5% and 2.0%. The prevalence of subclinical and overt hypothyroidism was 6.1% and 4.1%, and the prevalence of subclinical and overt hyperthyroidism was 2.4% and 1.4%, respectively. Family history of thyroid disorders was the most important predictor of hypothyroidism during pregnancy ( OR=2.6, 95% CI=1.0-6.6, P=0.002), while preterm delivery ( OR=2.2, 95% CI=1.3-6.8, P=0.220) and elevated neonate thyroid stimulating hormone ( OR=1.2, 95% CI=1.1-1.3, P=0.041) were the most important consequence of hypothyroidism. Conclusions: Hypothyroidism is a highly prevalent thyroid disorder in high-risk pregnant women. Thyroid function screening should be performed in all pregnant women to increase the detection of subclinical and overt hypothyroidism during pregnancy.

Keywords

Hypothyroidism / Thyroid disorder / Thyroid dysfunction / Thyroid stimulating hormone / Pregnancy

References

[1] Gholami S, Namiranian N, Shukohifar M, Kalantari F, Azizi R. Maternal thyroid function test level during the first trimester of pregnancy at a center Yazd, Iran: A cross—sectional study. Int J Reprod Biomed 2021; 19(3): 255-260.

[2] Erik KA, Elizabeth NP, Gregory AB, Rosalind SB, Herbert C, Chrysoula D, et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 2017; 27(3): 315-389.

[3] Etemadi A, Amouzegar A, Mehran L, Tohidi M, Azizi F, Moradi K, et al. Isolated hypothyroxinemia in Iranian pregnant women, the role of iodine deficiency: A population—based cross—sectional study. Thyroid 2020; 30(2): 262-269.

[4] Sepasi F, Rashidian T, Shokri M, Badfar G, Kazemi F, Azami M. Thyroid dysfunction in Iranian pregnant women: A systematic review and meta—analysis. BMC Pregnancy Childb 2020; 20(1): 405.

[5] Menotti S, Mura C, Raia S, Bergianti L, De Carolis S, Romeo DM, et al. Overt hypothyroidism in pregnancy and language development in offspring: is there an association? J Endocrinol Invest 2024. doi: 10.1007/s40618-024-02317-2.

[6] Dhanwal DK, Bajaj S, Rajput R, Subramaniam KA, Chowdhury S, Bhandari R, et al. Prevalence of hypothyroidism in pregnancy: An epidemiological study from 11 cities in 9 states of India. Indian J Endocrinol Metab 2016; 20(3): 387-390.

[7] Delshad H, Raeisi A, Abdollahi Z, Tohidi M, Hedayati M, Mirmiran P, et al. Iodine supplementation for pregnant women: A cross—sectional national interventional study. J Endocrinol Invest 2021; 44(10): 2307-2314.

[8] Askari S, Abdi H, Ahmadi S, Bahadoran Z, Amouzegar A. Knowledge of thyroid disorders during pregnancy among general practitioners in Iran. Int J Endocrinol Metab 2017; 15(3): e55450.

[9] Dulek H, Vural F, Aka N, Zengin S. The prevalence of thyroid dysfunction and its relationship with perinatal outcomes in pregnant women in the third trimester. North Clin Istanb 2019; 6(3): 267-272.

[10] Borzouei S, Goodarzi MT, Biglari M, Nazari F, Shivapour Z. The prevalence of thyroid disorders in pregnant women of Hamadan. Avicenna J Nurs Midwifery Care 2019; 27(1): 11-17.

[11] Lee SY, Cabral HJ, Aschengrau A, Pearce EN. Associations between maternal thyroid function in pregnancy and obstetric and perinatal outcomes. J Clin Endocrinol Metab 2020; 105(5): e2015-23.

[12] Pande A, Anjankar A. A narrative review on the effect of maternal hypothyroidism on fetal development. Cureus 2023; 15(2): e34824.

[13] Li P, Cui J, Li L, Chen X, Ouyang L, Fan J, et al. Association between isolated maternal hypothyroxinemia during the first trimester and adverse pregnancy outcomes in southern Chinese women: A retrospective study of 7 051 cases. BMC Pregnancy Childb 2022; 22(1): 866-872.

[14] Mir F, Chiti H, Mazloomzadeh S. Short—term adverse pregnancy outcomes in women with subclinical hypothyroidism: A comparative approach of Iranian and American guidelines. J Thyroid Res 2022; 2022: 9315250.

[15] Mehran L, Amouzegar A, Delshad H, Askari S, Hedayati M, Amirshekari G, et al. Trimester—specific reference ranges for thyroid hormones in Iranian pregnant women. J Thyroid Res 2013; 2013: 651517.

[16] Lee SY, Pearce EN. Assessment and treatment of thyroid disorders in pregnancy and the postpartum period. Nat Rev Endocrinol 2022; 18(3): 158-171.

[17] Croce L, Chiovato L, Tonacchera M, Petrosino E, Tanda ML, Moleti M, et al. Iodine status and supplementation in pregnancy: an overview of the evidence provided by meta—analyses. Rev Endocr Metab Disord 2023; 24(2): 241-250.

[18] Ramezani TF, Nazarpour S, Behboudi—Gandevani S. Isolated maternal hypothyroxinemia and adverse pregnancy outcomes: A systematic review. J Gynecol Obstet Hum Reprod 2021; 50(7): 102057.

[19] Gong X, Liu A, Li Y, Sun H, Li Y, Li C, et al. The impact of isolated maternal hypothyroxinemia during the first and second trimester of gestation on pregnancy outcomes: An intervention and prospective cohort study in China. J Endocrinol Invest 2019; 42(5): 599-607.

[20] Avramovska M, Karanfilski B, Dimitrov G, Dzikova E, Daneva Markova A, Hadzi Lega M, et al. Isolated maternal hypothyroxinemia and its perinatal outcome in north Macedonia. Acta Clin Croat 2021; 60(2): 246-253.

[21] Hernández M, López C, Soldevila B, Cecenarro L, Martínez—Barahona M, Palomera E, et al. Impact of TSH during the first trimester of pregnancy on obstetric and foetal complications: Usefulness of 2.5 mIU/L cut—off value. Clin Endocr 2018; 88(5): 728-734.

[22] Cooper DS, Laurberg P. Hyperthyroidism in pregnancy. Lancet Diabetes Endo 2013; 1(3): 238-249.

[23] Campos—Martorell A, Ramon AM, Barros KN, Soria JLM, Galera RML, Fernández DY, et al. Thyroid function in 509 premature newborns below 31 weeks of gestational age: Evaluation and follow—up. J Clin Res Pediatr Endocrinol 2022; 14(4): 453-462.

[24] Manousou S, Andersson M, Eggertsen R, Hunziker S, Hulthén L, Nyström HF. Iodine deficiency in pregnant women in Sweden: A national cross—sectional study. Eur J Nutr 2020; 59(6): 2535-2545.

[25] Marwaha RK, Chopra S, Gopalakrishnan S, Sharma B, Kanwar RS, Sastry A, et al. Establishment of reference range for thyroid hormones in normal pregnant Indian women. BJOG 2008; 115(5): 602-606.

[26] Haddow JE, Knight GJ, Palomaki GE, McClain MR, Pulkkinen AJ. The reference range and within—person variability of thyroid stimulating hormone during the first and second trimesters of pregnancy. J Med Screen 2004; 11(4): 170-174.