ENDEMIC HYPOTHYROID CHALLENGE ON THYROID STATUS OF PREGNANT WOMEN AND ADVERSE OUTCOMES

Main Article Content

Prof. Dr. Abdul Rehman Khokhar
Dr. Muhammad Rafique Dar
Prof. Dr. Abdul Majeed Cheema

Keywords

endemic hypothyroidism, pregnancy, thyroid function hormones, neonatal status, adverse outcomes

Abstract

Introduction: Pregnancy with thyroid dysfunction is a high risk for developing iodine deficit. All aspects of thyroid hormone economy affected by pregnancy. Thyroid Stimulating Hormone (TSH) level during pregnancy is most reliable test to assess thyroid functional status. Objectives: The study objectives were to assess pertinent thyroid functional hormones of pregnant women during last trimester and maternal & neonatal outcomes of pregnancy in this region. Materials & Methods: A cross sectional, hospital based study was conducted.  Convenient sampling technique was practiced. Sample size was calculated by Classical Sample size Cochran formula. Maternal Goiterous and clinically Non-goiterous maternal groups were recruited for thyroid function status and outcomes of pregnancy. Results: Serum TSH levels of maternal Goiterous group were 1.33 ± 0.144 mIU/l, serum free triiodothyronine (FT3) levels were 2.51 ± 0.608 pmol/l, and serum free thyroxin (FT4) were 0.92 ± 0.691 ng/dl. Comparing the maternal Non-goiterous group serum TSH levels were 1.760 ± 0.155 mIU/l, FT3 levels were 1.710 ± 0,381 pmol/l and serum FT4 were 1.310 ± 0.194 ng/dl. Independent t-test was applied to evaluate equality of means and variances, of both maternal groups. Results have shown statistically significant (P <0.05). On percentile analysis serum TSH levels of maternal Goiterous, group 5th, 50th (median), and 95th percentiles were 0.134, 1.090, and 3.508 mIU/l respectively. In Maternal-neonatal outcome high frequency of abortion (29.3%) and low birth weight (LBW) (10.6%) were observed among maternal Goiterous group, Early neonatal deaths occurred (< 7days) 9.33% among neonates of maternal Goiterous group. Conclusion: Reduced thyroid function due to endemic goitrous prevalence in the study region demands regular screening for thyroid disorders during pregnancy in order to avoid its adverse consequences on fetal and neonatal differentiating development in general however specifically of brain to avoid wide spread mental retardation.

Abstract 59 | PDF Downloads 44

References

1. Korevaar TI, Muetzel R, Medici M, Chaker L, Association of maternal thyroid function during early pregnancy with offspring IQ and brain morphology in childhood: a population based prospective cohort study, Lancet Diabetes Endocrinol 2016;4:35-43.
2. Ajmani SN, Aggarwal D, Bhatia P, Sharma M Sarabhai V, Paul M., Prevalence of overt and sub-clinical thyroid dysfunction among pregnant women and its effect on maternal and fetal outcome. J O G I. 2014; 64:105-10.
3. Liu H, Shan Z, Li C, Teng W, Maternal subclinical hypothyroidism, thyroid autoimmunity and the risk of miscarriage: a prospective cohort study. Thyroid 2014; 24:1642-9.
4. Khakurel G, Karki C, Chalise S, Prevalence of thyroid disorder in pregnant women visiting a tertiary care hospital: A descriptive Cross Sectional Study, JNMA 2022;15(233):59.
5. Galofre JC, Davis TF, Autoimmune thyroid disease in pregnancy: a review J Women Health (Larchint) 2009; 18:1847-56.
6. Rohner F, Zimmermann M, Jooste P, Pandav C, Calwell k, Ragharan R, et al. Biomarkers of nutrition for development, iodine review. J Nutr 2014; 144:1322 S-42.
7. Yadav V, Dabar D, Goel AD Prevalence of hypothyroidism in pregnant women in India: a meta-analysis of observational studies, J Thyroid Res 2021:2021.
8. WHO/UNICEF/ICC/IDD., Assessment of iodine deficiency disorders and monitoring their elimination, A guide for program managers, 3rd ed. Geneva World Health Organization 2007, accessed 15 March 2023 at http. // Who lib doc who Int/publications /2007/97892415827.
9. European Food Safety Authority (EFSA), scientific opinion on dietary reference values for iodine. Parma: European food Safety Authority 2014, accessed on 20 Sep 2022, at http:www.efsa.europa.eu/en/efsajournal/doc/3660.
10. Knosgaard L, Andersen S, Hansen AB, Vestergaard P, Anderson SL, Classification of maternal thyroid function in early pregnancy using repeated blood samples, Eur Thyroid J, 2022:11 (2): e210055.
11. Yuanzhi C, Zhong-Cheng L, Zhang T, Fan P, Rui Ma, Zhang J, Fengxia Ouyang Maternal thyroid dysfunction and Neuropsychological development in children. J Clin Endocrinol & Metabol, 2023;108: 339-50.doi.org/10.1210/clinem/dgac577.
12. Royal College Obstetrician and Gynecologist, Management of thyroid disorders in pregnancy: RCOG Green Top Guidelines (New), RCOG, 2023;1-50.
13. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al., Guidelines of American Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2017; 17:315-89.
14. De Groot L, Abalovich M, Alexander E, et al., Management of thyroid dysfunction during pregnancy and postpartum: Endocrine Society Clinical Practice guidelines. J Clin Endocrinol Metab.2012; 97:2543-2565.
15. Stagnaro-Green A, Abalovich M, Alexander E, et al., American Thyroid Association Task force on thyroid disease during pregnancy and postpartum: Guidelines of American Thyroid Association for diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid, 2011; 21:1081-1125.
16. Yang X, Meng Y, Zhang Y, Zhang C, Guo F, Yang S et al. Thyroid reference ranges during pregnancy in a large Chinese population and comparison with current guidelines. Chin Med J (Engl).2019; 132:505-11.
17. Almomin AMS, Mansour AA, Sharif M, Trimester-specific reference intervals of thyroid functions testing in pregnant women from Basrah, Iraq using electrochemical- I luminescent Immuno-assay, Disease. 2016; 4:20:1-11.
18. Alawad M, Modawe G, Abdraabo AA, Assessment of thyroid profile (FT3, FT4, TSH) in pregnant women with Pre-eclampsia. Int J Res Pharmacy Bio Sci, 2015;2(2):5-7.
19. Mahadik K, Choudhury P, Roy PK, Study of thyroid functions in pregnancy, its feto-maternal outcome: a prospective observational study, BMC Pregnancy Childbirth, 2020;20(1):769.
20. Feigl S, Obermayer-Pietsch B, Klaritsch P, Pregartner G, Herzong SA, Lerchbaum E, et al. impact of thyroid function on pregnancy and neonatal outcomes in women with and without PCOS, Biomedicines, 2022;10:750. Doi.org/10.3390/biomedicines10040750.
21. Yasmin S, Nadeem S, Javed A, Sehar N, Shakeel S, Anam A, A clinical study on thyroid dysfunction in pregnancy and its effects on the feto-maternal outcomes. PJMHS, 2022; 16(4):323-25. Doi.https://doi.org/10.53350/pjmhs22164323.
22. Kumar R, Banasal R, Shergill HK, Grag P, Prevalence of thyroid dysfunction in pregnancy and its association with feto-maternal outcomes: A prospective observational study from a tertiary care Institute in Northern India, Clin Epidemiology Global Health, 2023; 19:1-6. Doi; 101201.