‘’STUDY OF PREVALENCE OF HYPOTHYROIDISM IN PREGNANT WOMEN’S’’

Main Article Content

Dr Janhvi Mishra
Dr Richa Sharma
Dr. Priyanka Singh
Dr Kshama Shrivastava

Keywords

Hypothyroidism, pregnant women

Abstract

Introduction- Thyroid dysfunction is a common disorder in pregnancy which affects both maternal and fetal outcomes. There are very less and limited data on prevalence of hypothyroidism during pregnancy from India because no such big study done till now. this study done to define cut off value of serum TSH level in Indian pregnant women as hypothyroid and maternal and fetal outcomes. Aim of study is ‘’Study of prevalence of hypothyroidism and adverse foeto-maternal outcome Indian pregnant women’s’’


Material and Methods - This is a prospective and retrospective cohort study conducted in a period of 1.5 years between September 2021 to April 2023, in the department of Obstetrics & Gynecology GMC Shahdol in 1000 pregnant women’s who comes in antenatal checkup in opd. All healthy pregnant women with singleton pregnancy willing to participate in the study were enrolled. Women which have multiple pregnancy, known chronic medical disorder like diabetes, hypertension, any autoimmune disorder with hyperthyroidism or known hypothyroidism, bad obstetric history with a known cause are excluded from study.


However, there are few limitations of this study. We have not assessed trimester specific ranges. Follow up beyond newborn period was not possible because after discharge most infants either did not come for follow up or they were seen in pediatric clinic. We did not carry out thyroid examination using ultrasound, and we have not evaluated other causes of hypothyroidism in these women.


All pregnant women underwent ELISA TSH assay. Women with serum TSH >6.2mIU/L underwent Free Thyroxin (FT4) estimation and labelled as overt hypothyroid (OH) (group I) or subclinical hypothyroid (SCH) (group II). Women with serum TSH between 3-6.2mIU/L & 0.4-3mIU/L were labelled as group III & control. Foeto-maternal outcomes were compared between group I, II, III & controls


Result - The prevalence of SCH & OH was 6.4% and 3.8%. Pre-eclampsia, gestational DM & IUFD in group I and foetal distress in group II developed in significantly higher number of women (p=0.009, p=0.002, p=0.002 & p=0.004 respectively) Foeto-maternal variables assessed in group III none was significantly different from control group.


Conclusion –. There is a high prevalence of hypothyroidism and adverse foeto-maternal outcome is more commonly associated with OH as compared to SCH. TSH 3-6.2mIU/L may be taken as normal during pregnancy in the Indian population. We recommend a higher cut off for serum TSH to diagnose hypothyroidism ie >6.2mIU/L in Indian pregnant women. The strong point of this study is that we have included large number of subjects from India. From this study we know the level of thyroid cut off level in Indian pregnant women’s which can be used for diagnosis and treatment of this disorder

Abstract 225 | pdf Downloads 87

References

1. Dhanwal DK, Prasad S, Agarwal AK, Banerjee AK. High prevalence of subclinical hypothyroidism during first trimester of pregnancy in North India. Indian J Endocrinol Metab. 2013,Mar-Apr;17(2):281-284.
2. Klein RZ, Haddow JE, Faix JD, Brown RS, Hermos RJ, Pulkkinen A, Mitchell ML. Prevalence of thyroid deficiency in pregnant women. Clin Endocrinol. 1991;35:41-6.
3. Allan WC, Haddow JE, Palomaki GE, Williams JR, Mitchell ML, Hermos RJ, Faix JD, Klein R Z. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen. 2000;7:127-130
4. Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, Cunningham FG. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2005;105:239-45
5. Cleary-Goldman J, Malone FD, Lambert-Messerlian G, Sullivan L, Canick J, Porter TF, Luthy D, Gross S, Bianchi DW, D’Alton ME. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol. 2008;112:85–92.
6. Vaidya B, Anthony S, Bilous M, Shields B, Drury J, Hutchison S, Bilous R. Detection of thyroid dysfunction in early pregnancy: universal screening or targeted high-risk case finding? J Clin Endocrinol Metab. 2007;92:203–207.
7. Mannisto T, Vaarasmaki M, Pouta A, Hartikainen AL, Ruokonen A, Surcel HM, Bloigu A, Jarvelin MR, Suvanto-Luukkonen E. Perinatal outcome of children born to mothers with thyroid dysfunction or antibodies: a prospective population-based cohort study. J Clin Endocrinol Metab. 2009;94:772–779.
8. Benhadi N, Wiersinga WM, Reitsma JB, Vrijkotte TG, Bonsel GJ. Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death. Eur J Endocrinol. 2009;160(6):985–991.
9. Aziz N, Reddy P, Fernandez E. Hypothyroidism in pregnancy: Is universal screening needed? Obstet Gynecol India. 2006;56:495-498.
10. Sharma PP, Mukhopadhyay P, Mukhopadhyay A, Muraleedharan PD, Begum N. J. Obstet Gynecol India. 2007;57:331-334.
11. Marwaha RK, Chopra S, Gopalakrishnan S, Sharma B, Kanwar RS, Sastry A, Singh S. Establishment of reference range for thyroid hormones in normal pregnant Indian women. BJOG. 2008;115:602–606.
12. R Gayathri, S Lavanya, K Raghavan. Subclinical hypothyroidism and autoimmune thyroiditis in pregnancy - A study in South Indian subjects. JAPI. 2009;57:691-693.
13. Sahu MT, Das V, Mittal S, Agarawal A, Sahu M. Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome. Arch Gynecol Obst. 2010;281:215-220.
14. Nambiar V, Jagtap VS, Sarathi V, Lila AR, Kamalanathan S, Bandgar TR, Menon PS, Shah NS. Prevalence and impact of thyroid disorders on maternal outcome in Asian-Indian pregnant women. J Thyroid Res. 2011; 2011: 429097. Published online 2011 July 17. doi: 10.4061/2011/ 429097
15. Abalovich M, Amino N, Barbout LA, Cobin RH, DeGroot LJ, Glinoer D, Mandel SJ, Stagnaro-Green A. Management of thyroid dysfunction during pregnancy and postpartum: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2007;92(Supp 8):S1-S47.
16. Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy. J Clin Endocrinol Metab. 2010; 95:E44–8.
17. Bukshee K, Kriplani A, Kapil A, Bhargava VL, Takkar D. Hypothyroidism Complicating Pregnancy. ANZJOG. 1992;32:240-242.
18. Leung AS, Millar LK, Koonings PP, Montoro M, Mestman JH. Perinatal outcome in hypothyroid pregnancies. Obstet Gynecol. 1993;81:349–353.
19. Abalovich M, Gutierrez S, Alcaraz G, Maccallini G, Garcia A, Levalle O. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid. 2002 Jan12(1): 63–68.
20. Davis LE, Leveno KJ, Cunningham FG. Hypothyroidism complicating pregnancy. Obstet Gynecol. 1988;72(1):108–12.
21. Wasserstrum N, Ananla CA. Perinatal consequences of maternal hypothyroidism in early pregnancy and inadequate replacement. Clin Endocrinol. 1995;42:353-358.
22. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, Nixon A, Elizabeth N. Pearce EN, Soldin OP, Sullivan S, Wiersinga W. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. Thyroid. 2011;21:1-45.
23. Soldin OP, Tractenberg RE, Hollowell JG, Jonklass J, Janicic N, Solding SJ. Trimester-specific changes in maternal thyroid hormone, thyrotropin, and thyroglobulin concentrations during gestation: trends and associations across trimesters in iodine sufficiency. Thyroid 2004;14:1084–90.
24. Kurioka H, Takahashi K, Miyazaki K. Maternal thyroid function during pregnancy and puerperal period. Endocr J 2005;52:587–91.
25. La’ulu SL, Roberts WL. Second-trimester reference intervals for thyroid tests: the role of ethnicity. Clin Chem 2007;53:1658–64.
26. Marwaha RK, Tandon N, Gupta N, Karak AK, Verma K, Kochupillai N. Residual goitre in the postiodization phase: iodine status, thiocyanate exposure and autoimmunity. Clin Endocrinol (Oxf) 2003;59:672–81.
27. Gopalakrishnan S, Singh SP, Prasad WR, Jain SK, Ambardar VK, Sankar R. Prevalence of goitre and autoimmune thyroiditis in schoolchildren in Delhi, India after two decades of salt iodisation. J Pediatr Endocrinol Metab 2006;19:889–93.
28. Panesar NS, Li CY, Rogers MS. Reference intervals for thyroid hormones in pregnant Chinese women. Ann Clin Biochem. 2001;38:329–332.
29. Stricker R, Echenard M, Eberhart R, Chevailler MC, Perez V, Quinn FA, Stricker R. Evaluation of maternal thyroid function during pregnancy: the importance of using gestational age-specific reference intervals. Eur J Endocrinol. 2007;157:509–514.
30. Casey BM, Leveno KJ. Thyroid disease in pregnancy. Obstet Gynecol. 2006;108:1283-1292.
31. Poppe K, Glinoer D Thyroid autoimmunity and hypothyroidism before and during pregnancy. Hum Reprod Update 2003 9(2):149–161. doi:10.1093/humupd/dmg012
32. Rashid M, Rashid MH Obstetric management of thyroid disease. Obstet GynecolSurv 2007 62(10):680–688. doi:10.1097/01.ogx.0000281558.59184.b5 quiz 691
33. Lao TT Thyroid disorders in pregnancy. Curr Opin Obstet Gynecol 2005 17:123–127. doi:10.1097/01.gco.0000162179.15360.08