Association between second trimester maternal hypothyroidism and congenital heart diseases in fetuses: a retrospective study

Abstract

Aim: This study aimed to investigate the association between second-trimester maternal hypothyroidism and congenital heart diseases (CHDs) in fetuses. Material and Methods: This retrospective study was conducted at Obstetrics and Pediatrics Training and Research Hospital between June 2022 and December 2024. The patient group comprised mothers of children diagnosed with major CHDs, while the control group included mothers of children without CHDs or with minor anomalies not requiring intervention. Maternal thyroid status was determined by second-trimester TSH levels: >4.0 mIU/mL was classified as hypothyroid, while 0.2–4.0 mIU/mL was considered euthyroid. Statistical analyses, including ROC analysis, regression analysis, Chi-square test, Fisher's exact test, and Mann-Whitney U test, were performed using SPSS 25, with p < 0.05 considered significant. Results: The median TSH level was significantly higher in the CHD group compared to controls (p = 0.002). Logistic regression analysis revealed that each unit increase in maternal TSH levels increased the risk of fetal CHD by 1.47 times (95% CI: 1.212–1.792, p < 0.001). ROC analysis determined an optimal TSH cutoff of 1.795 mIU/mL (AUC = 0.627; sensitivity: 59.6%, specificity: 59.4%). While differences in CHD subgroups were observed, including conotruncal and valvular defects, these did not reach statistical significance (p > 0.05). Conclusion: The study suggests a potential association between maternal hypothyroidism and fetal CHD.

Keywords

• Maternal hypothyroidism
• congenital heart disease
• fetal echocardiography
• thyroid function
• second trimester.

Supporting Institution

The authors received no financial support for the research and/or authorship of this article.

Ethical Statement

The study was approved by the Institutional Ethics Review Board for Clinical Research of Giresun Education and Research Hospital Ethics Committee (approval date: 25.12.2024; approval number: 2024/02). Written informed consent was obtained from the patients prior to inclusion in the study.

Maternal hipotiroidi ile fetal konjenital kalp hastalıkları arasındaki ilişki: retrospektif bir çalışma

Abstract

Amaç: Bu çalışma, ikinci trimesterdeki maternal hipotiroidi ile fetal konjenital kalp hastalıkları (KKH) arasındaki ilişkiyi araştırmayı amaçladı. Gereç ve Yöntemler: Bu retrospektif çalışma, Haziran 2022 ile Aralık 2024 tarihleri arasında Kadın Doğum ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi'nde gerçekleştirildi. Hasta grubu, majör konjenital kalp hastalığı tanısı alan çocukların annelerinden oluşurken, kontrol grubu KKH olmayan veya müdahale gerektirmeyen minör anomalilere sahip çocukların annelerini içeriyordu. Annelerin tiroid durumu, ikinci trimesterde ölçülen TSH seviyelerine göre belirlendi: >4,0 mIU/mL hipotiroid, 0,2–4,0 mIU/mL ötiroid olarak kabul edildi. İstatistiksel analizler arasında ROC analizi, regresyon analizi, Ki-kare testi, Fisher'ın kesin testi ve Mann-Whitney U testi yer almakta olup, tüm analizler SPSS 25 kullanılarak gerçekleştirildi ve p < 0,05 anlamlı kabul edildi. Bulgular: Medyan TSH seviyesi, KKH grubunda kontrol grubuna göre anlamlı derecede daha yüksek bulundu (p = 0,002). Lojistik regresyon analizinde, maternal TSH seviyelerindeki her bir birimlik artışın fetal KKH riskini 1,47 kat artırdığı tespit edildi (95% CI: 1,212–1,792, p < 0,001). ROC analizi, TSH için optimal eşik değerini 1,795 mIU/mL olarak belirledi (AUC = 0,627; duyarlılık: %59,6, özgüllük: %59,4). Konotrunkal ve valvüler defektler gibi KKH alt gruplarında farklılıklar gözlenmiş olsa da, bu farklar istatistiksel anlamlılığa ulaşmadı (p > 0,05). Sonuç: Çalışma, maternal hipotiroidizm ile fetal KKH arasında potansiyel bir ilişki olabileceğini göstermektedir.

Keywords

• Maternal hipotiroidizm
• konjenital kalp hastalığı
• fetal ekokardiyografi
• tiroid fonksiyonu
• ikinci trimester

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