The Association of First Trimester TSH Levels With Obstetric and Perinatal Outcomes

Abstract

Aim: To investigate the association of first trimester TSH levels in pregnant woman with the fetal birth weights.Material and Methods : The study was a retrospective study at Ankara University Ostetrics and Gynecology in January 2014 to January 2015 . 397 singleton pregnancies, the first trimester were included in the study. Thyroid disease history, diabetes mellitus, preeclampsia, heart disease, cigarettes and alcohol use, birth before 37 weeks of gestation were excluded from study. Patients were divided into two groups according to TSH levels. TSH levels in the first group of 0.5-2.5 mU / L Group 1:202 patients and the second group TSH level 2.5-5 mU / L Group 2:195 patients , respectively. Groups were compared with gestational age, birth weight, gravity, parity, Apgar scores, 50 g oral glucose tolerance test OGTT results, method of delivery, premature rupture of membranes, intrauterine growth retardation IUGR , pregnancy -induced hypertension PIH , placental abruption, miscarriage, fetal death.Patients were divided into 3 groups according to birth weights 4000 g and compared birth weights according to TSH levels .Results : Cesarean delivery was observed at higher rates in group 2, respectively, and the difference was statistically significant p = 0.018 . 5th minute Apgar scores was statistically significantly higher in group 1 p=0,002 . Birth weight results were similar in groups and a statistically significant difference was not observed p = 0.41 Conclusion: Thyroid dysfunctions have a negative impact on the pregnancies and we need for further studies to determine the relationship with first trimester TSH levels and fetal birth weight

Keywords

• First trimester TSH levels,thyroid disfunction,fetal birth weight

İlk Trimester TSH Düzeyinin Obstetrik ve Perinatal Sonuçlara Etkisi

Abstract

Amaç: Gebelerde ilk trimester TSH seviyelerinin fetal doğum ağırlıklarına etkisini araştırmakGereç ve Yöntemler: Çalışmamız retrospektif bir çalışma olup Ankara Üniversitesi Kadın hastalıkları ve doğum bölümüne Ocak 2014-Ocak 2015 yılları arasında başvuran gebeliğinin ilk trimesterinde, tekil gebeliği olan 397 hasta dahil edilmiştir. Tiroid hastalıkları nedeniyle tedavi alanlar, diabetes mellitusu olanlar, preeklampsi gelişenler, kalp hastalığı olanlar, sigara ve alkol kullananlar ,37 haftadan önce doğum yapanlar çalışma dışı bırakılmıştır. Hastalar TSH seviyelerine göre iki gruba ayrıldı. Birinci grupta TSH seviyesi 0,5-2,5 mU/L Grup 1:202 hasta ve ikinci grupta TSH seviyesi 2,5-5 mU/L Grup 2:195 hasta idi. Gruplar doğum haftası, doğum kilosu, gravida, parite, Apgar skorları ,50 gr oral glukoz tolerans testi OGTT sonuçları, doğum şekli , erken membran rüptürü, intrauterin gelişme geriliği IUGR ,gebeliğin indüklediği hipertansiyon PIH , plasenta dekolmanı, abortus, intrauterin ölüm açısından karşılaştırılmıştır. Hastalar bebek doğum ağırlıklarına göre 3 gruba ayrıldı. Bunlar 2500 gram altı, 2500-4000 gram arası, 4000 gram üzerine göre sınıflandırıldı ve TSH düzeylerine göre bebek doğum ağırlıkları karşılaştırıldı.Sonuç : Gruplar arasında sezeryan doğum açısından TSH =2,5-5,0 mU/l olan grupta Grup 2 daha yüksek oranda idi ve istatistiksel olarak anlamlı fark izlendi p=0,018 . Her iki grup arasında 5. dakika Apgar skorları grup 1’de istatistiksel olarak anlamlı yüksek idi p=0,002 . Her iki TSH grubunda da doğum ağırlıkları açısından sonuçlar benzerdi ve istatistiksel olarak anlamlı bir fark izlenmedi p=0,41 .Tartışma : Tiroid fonksiyon bozukluklarının gebeliğin seyrine olumsuz etkisi bilinmektedir. İlk trimester TSH düzeyinin fetal doğum ağırlığına etkisini ortaya koymak için daha geniş çalışmalara ihtiyaç vardır.

Keywords

• İlk trimester TSH seviyeleri,tiroid disfonksiyonu,fetal doğum ağırlığı

References

1. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, Nixon A, 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 The American Th- yroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum Thyroid. 2011; 21: 1081–1125 .
2. Abalovich MA, Nobuyuki B, Linda C, De Groot RH, Glinoer LJ, Mandel D, Stagnaro-Green SJ. Management of thyroid dysfunction during pregnan- cy and postpartum: an Endocrine Society Clinical Practice Guideline. The Journal of clinical endocrinology and metabolism 2007,92,8:1-47
3. Abalovich MA, Kleiman-Rubinsztein G, Pavlove J, Cornelio MM, Leval- le C, Gutierrez O.The relationship of preconception thyrotropin levels to requirements for increasing the levothyroxine dose during pregnancy in women with primary hypothyroidism. Thyroid : official journal of the American Thyroid Association 2010,20,10:1175-8.
4. ACOG Practice Bulletin Number 148: Thyroid disease in pregnan- cy,2015;125:996-1005
5. Haddow J E, Knight G J, Palomaki G E,McClain MR, Pulkkinen J The refe- rence range and within-person variability of thyroid stimulating hormone during the first and second trimesters of pregnancy. Journal of medical screening 2004;11;4:170-4
6. Soldin OP,Tractenberg RE, Hollowell JG, Jonklaas J, Janicic N, Soldin SJ. Trimester-specific changes in maternal thyroid hormone, thyrotropin, and thyroglobulin concentrations during gestation: Trends and associati- ons across trimesters in iodine sufficiency Thyroid. 2004;14;12:1084- 90
7. Panesar NS,Li C Y, Rogers M S. Reference intervals for thyroid hor- mones in pregnant Chinese women. Annals of clinical biochemistry 2001;38;4:329-32
8. Marwaha RK, Chopra S, Gopalakrishnan S, Sharma B, Kanwar RS, Sastry A, Singh S. Establishment of reference range for thyroid hor- mones in normal pregnant Indian women. Br J Obstet Gynecol 2008 Apr;115(5):602-6

9. De Groot L. Management of thyroid dysfunction during pregnancy and postpartum : an Endocrine Society clinical practice guideline. J Clin En- docrinol Metab. 2012;97;2543-65
10. RobertoSchwartz N, Gismondi A, Tinelli R, Mangieri A, Stagnaro-Green T .Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy Journal of Clinical Endocrinology and Metabolism 2010,95,44-45.
11. Benhadi N,Wiersinga WM, Reitsma JB,Vrijkotte T,Bonsel GJ. Higher ma- ternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death European Journal of Endocrinology 2009;160;6:985-91
12. Smallridge RC, Ladenson PW. J Clin Endocrinol Metab. Hypothyroidism in pregnancy: consequences to neonatal health. 2001;86:2349-53.
13. De Vivo A, Thyroid function in women found to have early pregnancy loss.Thyroid 2010:20:633-637
14. Medici M, Timmermans S, Visser W, de Muinck Keizer-Schrama SM, Jaddoe VW, Hofman A, Hooijkaas H, de Rijke YB, Tiemeier H, Bon- gers-Schokking JJ, Visser TJ, Peeters RP, Steegers EA.Maternal thyroid hormone parameters during early pregnancy and birth weight: the Gene- ration R Study.J Clin Endocrinol Metab 2013;98:59-66.Epub November 12, 2012; doi: 10.1210/jc.2012-2420
15. Achit S,Dhar T, Awasthi K, Uppal B ,Jacob J. Obstetrical and neonatal outcomes in pregnant women with serum thyroid-stimulating hormone (TSH) levels >2.0 mU/L vs. those with TSH
16. Vitacolonna EL , Annunziata DN, Passante B, Bucci A, Giuliani I, Cerrone C, Capani D, Monaco F, Napolitano F.Gestational diabe- tes and thyroid autoimmunity. Int J Endoc 2012, Article ID 867415, doi:10.1155/2012/867415867415-21.
17. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies Thyroid disease and gestational diabetes mellitus (GDM): is there a connection? The International Society of Peri- natal Obstetricians 2013;26;11:1139-42.
18. Hage M, Zantout MS, Azar ST. Thyroid disorders and diabetes mellitus. Journal of thyroid research 2011.