Klinik Araştırma
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Gebelerde İlk Trimester Tiroid Stimülan Hormon Düzeyinin Obstetrik ve Perinatal Sonuçlara Etkisi

Yıl 2024, , 146 - 151, 20.12.2024
https://doi.org/10.57221/izmirtip.1491301

Öz

ÖZET
Amaç: Gebelerde ilk trimesterde ölçülen trioid stimülan hormon değerlerinin bebek doğum ağırlığı, doğum haftası, doğum şekli ve Apgar skorları üzerine etkisini araştırmak

Gereç ve Yöntemler: Çalışmamız; Erzincan Mengücekgazi Eğitim ve Araştırma Hastanesi kadın hastalıkları ve doğum bölümünde Ocak 2023-Aralık 2023 tarihleri arasında doğum yapmış ve ilk trimesterde bakılmış troid stimülan hormon değerlerine ulaşılabilen hastaların verilerinin retrospektif olarak değerlendirildiği bir çalışmadır. Bu tarihler arasındaki sezeryan ve normal doğum yapmış 1031 hastanın 986’sının TSH değerlerine ulaşılabilmiş ve tiroid hastalıkları nedeni ile tedavi alan, öncesinde diabeti ve hipertansiyonu olan, sigara ve alkol kullanan hastalar çalışma dışında bırakılmıştır. Hastalar TSH değerlerine göre 3 gruba ayrılarak değerlendirilmiştir. Gruplar doğum haftası, doğum kilosu, gravida, parite ve abortus sayıları, Apgar skorları, 50/75 gr OGTT sonuçları, doğum şekli ve gebelik komplikasyonları açısından karşılaştırılmıştır. TSH değerleri ve bebek doğum ağırlıkları açısından da değerlendirme yapılmıştır.

Sonuç: TSH değerlerine göre ayrılan gruplar ile bebek doğum ağırlıkları arasında anlamlı bir fark gözlenmezken, obstetrik komplikasyonların sıklığının az olması nedeni ile risk değerlendirilmesi yapılamamakla birlikte gruplar arasında fark izlenmedi. Hastaların sadece 272 tanesinin OGTT yatırmış olduğu ve Gestasyonel Diabetes Mellitus tanısı alan 21 hastanın 18 inde ilk trimesterde bakılan TSH değerlerinin normal aralıkta olduğu 3 hastada ise TSH değerlerinin yüksek olduğu tespit edildi.

Tartışma: Bizim çalışmamızda da literatürle benzer şekilde bebek doğum ağırlığı, APGAR skorları, doğum şekli ve gebelik komplikasyonları ile TSH seviyeleri arasında anlamlı bir fark bulunmamaktaydı.

Anahtar kelimeler: tiroid stimülan hormon, gebelik, sezeryan doğum oranları

Kaynakça

  • 1. Huang C, Wu Y, Chen L, Yuan Z, Yang S, Liu C. Establishment of assay method‐and trimester‐specific reference intervals for thyroid hormones during pregnancy in Chengdu, China. J Clin Lab Anal. 2021;35:e23763.
  • 2. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017;27:315-89.
  • 3. Osinga JA, Derakhshan A, Palomaki GE, Ashoor G, Männistö T, Maraka S, et al. TSH and FT4 reference intervals in pregnancy: a systematic review and individual participant data meta-analysis. J Clin Endocrinol Metab. 2022;107:2925-33.
  • 4. 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;11:170-4.
  • 5. Zhu P, Chu R, Pan S, Lai X, Ran J, Li X. Impact of TPOAb-negative maternal subclinical hypothyroidism in early pregnancy on adverse pregnancy outcomes. Ther Adv Endocrinol Metab. 2021;12:20420188211054690.
  • 6. Veltri F, Kleynen P, Grabczan L, Salajan A, Rozenberg S, Pepersack T, et al. Pregnancy outcomes are not altered by variation in thyroid function within the normal range in women free of thyroid disease. Eur J Endocrinol. 2018;178:189-97.
  • 7. Casey BM, Thom EA, Peaceman AM, Varner MW, Sorokin Y, Hirtz DG, et al. Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy. N Engl J Med. 2017;376:815-25.
  • 8. 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;9:255-60.
  • 9. Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab. 2010;95:1699-707.
  • 10. Polk DH. Thyroid hormone metabolism during development. Reprod Fertil Dev. 1995;7:469-77.
  • 11. Klein AH, Oddie TH, Parslow M, Foley TP, Jr., Fisher DA. Developmental changes in pituitary-thyroid function in the human fetus and newborn. Early Hum Dev. 1982;6:321-30.
  • 12. Gynecol O. Practice Bulletin No. 148: Thyroid disease in pregnancy. Obstet Gynecol. 2015;125:996-1005.
  • 13. Akarsu E, Alagöl F, Altun B, Aral F, G A, editors. Tiroid hastalıkları tanı ve tedavi kılavuzu. 2016: Türkiye Endokrinoloji ve Metabolizma Derneği; 2016.
  • 14. Bakırcı M, Kılıç F, Ersak B, Arslan H, Selcuk İ. Gebelerde ilk trimester TSH seviyelerinin fetal doğum ağırlıklarına ve maternal hemoglobin değerleri üzerine etkisi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2021;18:742-5.
  • 15. Surks MI, Hollowell JG. Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism. J Clin Endocrinol Metab. 2007;92:4575-82.
  • 16. Chakraborti S, Chakraborti T, Mandal M, Das S, Batabyal SK. Hypothalamic–pituitary–thyroid axis status of humans during development of ageing process. Clinica Chimica Acta. 1999;288:137-45.
  • 17. Li C, Shan Z, Mao J, Wang W, Xie X, Zhou W, et al. Assessment of thyroid function during first-trimester pregnancy: what is the rational upper limit of serum TSH during the first trimester in Chinese pregnant women? J Clin Endocrinol Metab. 2014;99:73-9.
  • 18. Kabaca S, Bozdağ H, Öğütçüoğlu FBS, Gökdağlı F, Kavak H, Tanyolaç NC. İlk trimester gebeliklerde subklinik tiroid fonksiyon bozuklukları ve obstetrik sonuçlar üzerine etkisi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2016;13:143-7.
  • 19. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 201;21:1081-125.
  • 20. Sağlam A. İlk trimester gebeliklerinde subklinik ve aşikar hipotiroidi insidansı. Medical Journal of Süleyman Demirel University, Tıp Fakültesi Dergisi. 2022;29:1-6.
  • 21. Korevaar TI, Medici M, Visser TJ, Peeters RP. Thyroid disease in pregnancy: new insights in diagnosis and clinical management. Nat Rev Endocrinol. 2017;13:610-22.
  • 22. Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014;3:76-94.
  • 23. Arbib N, Hadar E, Sneh-Arbib O, Chen R, Wiznitzer A, Gabbay-Benziv R. First trimester thyroid stimulating hormone as an independent risk factor for adverse pregnancy outcome. J Matern Fetal Neonatal Med. 2017;30:2174-78.
  • 24. Casey BM, Dashe JS, Spong CY, McIntire DD, Leveno KJ, Cunningham GF. Perinatal significance of isolated maternal hypothyroxinemia identified in the first half of pregnancy. Obstet Gynecol. 2007;109:1129-35.
  • 25. Medici M, Timmermans S, Visser W, de Muinck Keizer-Schrama SM, Jaddoe VW, Hofman A, et al. Maternal thyroid hormone parameters during early pregnancy and birth weight: the Generation R Study. J Clin Endocrinol Metab. 2013;98:59-66.
  • 26. 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< 2.0 in the first trimester of pregnancy. Endocr Rev. 2011;32:15-24.
  • 27. Schneuer FJ, Nassar N, Tasevski V, Morris JM, Roberts CL. Association and predictive accuracy of high TSH serum levels in first trimester and adverse pregnancy outcomes. J Clin Endocrinol Metab. 2012;97:3115-22.
  • 28. Cleary-Goldman J, Malone FD, Lambert-Messerlian G, Sullivan L, Canick J, Porter TF, et al. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol. 2008;112:85-92.
  • 29. 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:e2015-e23.

The Effect of First Trimester Thyroid Stimulating Hormone Levels on Obstetric and Perinatal Outcomes in Pregnant Women

Yıl 2024, , 146 - 151, 20.12.2024
https://doi.org/10.57221/izmirtip.1491301

Öz

Objective: To investigate the effect of thyroid stimulating hormone levels measured in the first trimester on infant birth weight, birth week, mode of delivery and APGAR scores in pregnant women

Materials and Methods: Our study was a retrospective evaluation of the data of patients who gave birth between January 2023 and December 2023 in the department of obstetrics and gynecology of Erzincan Mengücekgazi Training and Research Hospital and whose TSH (thyroid stimulating hormone) values could be accessed in the first trimester. TSH values of 986 of 1031 patients who had cesarean and normal deliveries between these dates were available, and patients who were receiving treatment for thyroid diseases, who had diabetes and hypertension, and who smoked and drank alcohol were excluded from the study. Patients were divided into 3 groups according to TSH values. The groups were compared in terms of gestational week, birth weight, gravida, parity and number of abortions, APGAR scores, 50/75 g OGTT (Oral Glucose Tolerance Test) results, mode of delivery and pregnancy complications. TSH levels and infant birth weights were also evaluated.

Results: No significant difference was observed between the groups divided according to TSH values and infant birth weights, while no difference was observed between the groups, although risk assessment could not be performed due to the low frequency of obstetric complications. It was determined that only 272 of the patients had undergone OGTT and TSH values in the first trimester were in the normal range in 18 of 21 patients diagnosed with Gestational Diabetes Mellitus and TSH values were high in 3 patients.

Discussion: Similar to the literature, there was no significant difference between TSH levels and infant birth weight, APGAR scores, mode of delivery and pregnancy complications in our study.

Kaynakça

  • 1. Huang C, Wu Y, Chen L, Yuan Z, Yang S, Liu C. Establishment of assay method‐and trimester‐specific reference intervals for thyroid hormones during pregnancy in Chengdu, China. J Clin Lab Anal. 2021;35:e23763.
  • 2. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017;27:315-89.
  • 3. Osinga JA, Derakhshan A, Palomaki GE, Ashoor G, Männistö T, Maraka S, et al. TSH and FT4 reference intervals in pregnancy: a systematic review and individual participant data meta-analysis. J Clin Endocrinol Metab. 2022;107:2925-33.
  • 4. 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;11:170-4.
  • 5. Zhu P, Chu R, Pan S, Lai X, Ran J, Li X. Impact of TPOAb-negative maternal subclinical hypothyroidism in early pregnancy on adverse pregnancy outcomes. Ther Adv Endocrinol Metab. 2021;12:20420188211054690.
  • 6. Veltri F, Kleynen P, Grabczan L, Salajan A, Rozenberg S, Pepersack T, et al. Pregnancy outcomes are not altered by variation in thyroid function within the normal range in women free of thyroid disease. Eur J Endocrinol. 2018;178:189-97.
  • 7. Casey BM, Thom EA, Peaceman AM, Varner MW, Sorokin Y, Hirtz DG, et al. Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy. N Engl J Med. 2017;376:815-25.
  • 8. 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;9:255-60.
  • 9. Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab. 2010;95:1699-707.
  • 10. Polk DH. Thyroid hormone metabolism during development. Reprod Fertil Dev. 1995;7:469-77.
  • 11. Klein AH, Oddie TH, Parslow M, Foley TP, Jr., Fisher DA. Developmental changes in pituitary-thyroid function in the human fetus and newborn. Early Hum Dev. 1982;6:321-30.
  • 12. Gynecol O. Practice Bulletin No. 148: Thyroid disease in pregnancy. Obstet Gynecol. 2015;125:996-1005.
  • 13. Akarsu E, Alagöl F, Altun B, Aral F, G A, editors. Tiroid hastalıkları tanı ve tedavi kılavuzu. 2016: Türkiye Endokrinoloji ve Metabolizma Derneği; 2016.
  • 14. Bakırcı M, Kılıç F, Ersak B, Arslan H, Selcuk İ. Gebelerde ilk trimester TSH seviyelerinin fetal doğum ağırlıklarına ve maternal hemoglobin değerleri üzerine etkisi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2021;18:742-5.
  • 15. Surks MI, Hollowell JG. Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism. J Clin Endocrinol Metab. 2007;92:4575-82.
  • 16. Chakraborti S, Chakraborti T, Mandal M, Das S, Batabyal SK. Hypothalamic–pituitary–thyroid axis status of humans during development of ageing process. Clinica Chimica Acta. 1999;288:137-45.
  • 17. Li C, Shan Z, Mao J, Wang W, Xie X, Zhou W, et al. Assessment of thyroid function during first-trimester pregnancy: what is the rational upper limit of serum TSH during the first trimester in Chinese pregnant women? J Clin Endocrinol Metab. 2014;99:73-9.
  • 18. Kabaca S, Bozdağ H, Öğütçüoğlu FBS, Gökdağlı F, Kavak H, Tanyolaç NC. İlk trimester gebeliklerde subklinik tiroid fonksiyon bozuklukları ve obstetrik sonuçlar üzerine etkisi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2016;13:143-7.
  • 19. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 201;21:1081-125.
  • 20. Sağlam A. İlk trimester gebeliklerinde subklinik ve aşikar hipotiroidi insidansı. Medical Journal of Süleyman Demirel University, Tıp Fakültesi Dergisi. 2022;29:1-6.
  • 21. Korevaar TI, Medici M, Visser TJ, Peeters RP. Thyroid disease in pregnancy: new insights in diagnosis and clinical management. Nat Rev Endocrinol. 2017;13:610-22.
  • 22. Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014;3:76-94.
  • 23. Arbib N, Hadar E, Sneh-Arbib O, Chen R, Wiznitzer A, Gabbay-Benziv R. First trimester thyroid stimulating hormone as an independent risk factor for adverse pregnancy outcome. J Matern Fetal Neonatal Med. 2017;30:2174-78.
  • 24. Casey BM, Dashe JS, Spong CY, McIntire DD, Leveno KJ, Cunningham GF. Perinatal significance of isolated maternal hypothyroxinemia identified in the first half of pregnancy. Obstet Gynecol. 2007;109:1129-35.
  • 25. Medici M, Timmermans S, Visser W, de Muinck Keizer-Schrama SM, Jaddoe VW, Hofman A, et al. Maternal thyroid hormone parameters during early pregnancy and birth weight: the Generation R Study. J Clin Endocrinol Metab. 2013;98:59-66.
  • 26. 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< 2.0 in the first trimester of pregnancy. Endocr Rev. 2011;32:15-24.
  • 27. Schneuer FJ, Nassar N, Tasevski V, Morris JM, Roberts CL. Association and predictive accuracy of high TSH serum levels in first trimester and adverse pregnancy outcomes. J Clin Endocrinol Metab. 2012;97:3115-22.
  • 28. Cleary-Goldman J, Malone FD, Lambert-Messerlian G, Sullivan L, Canick J, Porter TF, et al. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol. 2008;112:85-92.
  • 29. 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:e2015-e23.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Endokrinoloji, Kadın Hastalıkları ve Doğum
Bölüm Araştırma Makaleleri
Yazarlar

Betül Kalkan Yılmaz 0000-0003-4742-5308

Okay Alptekin 0000-0001-6404-4158

Yayımlanma Tarihi 20 Aralık 2024
Gönderilme Tarihi 28 Mayıs 2024
Kabul Tarihi 1 Ekim 2024
Yayımlandığı Sayı Yıl 2024

Kaynak Göster

APA Kalkan Yılmaz, B., & Alptekin, O. (2024). Gebelerde İlk Trimester Tiroid Stimülan Hormon Düzeyinin Obstetrik ve Perinatal Sonuçlara Etkisi. İzmir Tıp Fakültesi Dergisi, 3(4), 146-151. https://doi.org/10.57221/izmirtip.1491301
AMA Kalkan Yılmaz B, Alptekin O. Gebelerde İlk Trimester Tiroid Stimülan Hormon Düzeyinin Obstetrik ve Perinatal Sonuçlara Etkisi. İzmir Tıp Fak. Derg. Aralık 2024;3(4):146-151. doi:10.57221/izmirtip.1491301
Chicago Kalkan Yılmaz, Betül, ve Okay Alptekin. “Gebelerde İlk Trimester Tiroid Stimülan Hormon Düzeyinin Obstetrik Ve Perinatal Sonuçlara Etkisi”. İzmir Tıp Fakültesi Dergisi 3, sy. 4 (Aralık 2024): 146-51. https://doi.org/10.57221/izmirtip.1491301.
EndNote Kalkan Yılmaz B, Alptekin O (01 Aralık 2024) Gebelerde İlk Trimester Tiroid Stimülan Hormon Düzeyinin Obstetrik ve Perinatal Sonuçlara Etkisi. İzmir Tıp Fakültesi Dergisi 3 4 146–151.
IEEE B. Kalkan Yılmaz ve O. Alptekin, “Gebelerde İlk Trimester Tiroid Stimülan Hormon Düzeyinin Obstetrik ve Perinatal Sonuçlara Etkisi”, İzmir Tıp Fak. Derg., c. 3, sy. 4, ss. 146–151, 2024, doi: 10.57221/izmirtip.1491301.
ISNAD Kalkan Yılmaz, Betül - Alptekin, Okay. “Gebelerde İlk Trimester Tiroid Stimülan Hormon Düzeyinin Obstetrik Ve Perinatal Sonuçlara Etkisi”. İzmir Tıp Fakültesi Dergisi 3/4 (Aralık 2024), 146-151. https://doi.org/10.57221/izmirtip.1491301.
JAMA Kalkan Yılmaz B, Alptekin O. Gebelerde İlk Trimester Tiroid Stimülan Hormon Düzeyinin Obstetrik ve Perinatal Sonuçlara Etkisi. İzmir Tıp Fak. Derg. 2024;3:146–151.
MLA Kalkan Yılmaz, Betül ve Okay Alptekin. “Gebelerde İlk Trimester Tiroid Stimülan Hormon Düzeyinin Obstetrik Ve Perinatal Sonuçlara Etkisi”. İzmir Tıp Fakültesi Dergisi, c. 3, sy. 4, 2024, ss. 146-51, doi:10.57221/izmirtip.1491301.
Vancouver Kalkan Yılmaz B, Alptekin O. Gebelerde İlk Trimester Tiroid Stimülan Hormon Düzeyinin Obstetrik ve Perinatal Sonuçlara Etkisi. İzmir Tıp Fak. Derg. 2024;3(4):146-51.