Volume 13, Issue 7 (9-2015)                   IJRM 2015, 13(7): 387-396 | Back to browse issues page

XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Nazarpour S, Ramezani Tehrani F, Simbar M, Azizi F. Thyroid dysfunction and pregnancy outcomes. IJRM 2015; 13 (7) :387-396
URL: http://ijrm.ir/article-1-667-en.html
1- Department of Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran , ramezani@endocrine.ac.ir
3- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract:   (6766 Views)
Background: Pregnancy has a huge impact on the thyroid function in both healthy women and those that have thyroid dysfunction. The prevalence of thyroid dysfunction in pregnant women is relatively high.
Objective: The objective of this review was to increase awareness and to provide a review on adverse effect of thyroid dysfunction including hyperthyroidism, hypothyroidism and thyroid autoimmune positivity on pregnancy outcomes.
Materials and Methods: In this review, Medline, Embase and the Cochrane Library were searched with appropriate keywords for relevant English manuscript. We used a variety of studies, including randomized clinical trials, cohort (prospective and retrospective), case-control and case reports. Those studies on thyroid disorders among non-pregnant women and articles without adequate quality were excluded.
Results: Overt hyperthyroidism and hypothyroidism has several adverse effects on pregnancy outcomes. Overt hyperthyroidism was associated with miscarriage, stillbirth, preterm delivery, intrauterine growth retardation, low birth weight, preeclampsia and fetal thyroid dysfunction. Overt hypothyroidism was associated with abortion, anemia, pregnancy-induced hypertension, preeclampsia, placental abruption, postpartum hemorrhage, premature birth, low birth weight, intrauterine fetal death, increased neonatal respiratory distress and infant neuro developmental dysfunction. However the adverse effect of subclinical hypothyroidism, and thyroid antibody positivity on pregnancy outcomes was not clear. While some studies demonstrated higher chance of placental abruption, preterm birth, miscarriage, gestational hypertension, fetal distress, severe preeclampsia and neonatal distress and diabetes in pregnant women with subclinical hypothyroidism or thyroid autoimmunity; the other ones have not reported these adverse effects.
Conclusion: While the impacts of overt thyroid dysfunction on feto-maternal morbidities have been clearly identified and its long term impact on childhood development is well known, data on the early and late complications of subclinical thyroid dysfunction during pregnancy or thyroid autoimmunity are controversial. Further studies on maternal and neonatal outcomes of subclinical thyroid dysfunction maternal are needed.
Full-Text [PDF 490 kb]   (993 Downloads) |   |   Full-Text (HTML)  (548 Views)  
Type of Study: Original Article |

References
1. Ramezani Tehrani F, Aghaee M, Asefzadeh S. The comparison of thyroid function tests in cord blood following cesarean section or vaginal delivery. Int J Endocrinol Metab 2003; 1: 22-26.
2. Zadeh-Vakili A, Ramezani Tehrani F, Hashemi S, Amouzegar A, Azizi F. Relationship between Sex Hormone Binding Globulin, Thyroid Stimulating Hormone, Prolactin and Serum Androgens with Metabolic Syndrome Parameters in Iranian Women of Reproductive Age. Diabetes Metabolism 2012: S:2. Available at: http://dx.doi.org/10.4172/2155-6156.S2-008. [DOI:10.4172/2155-6156.S2-008]
3. The American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and Postpartum. Thyroid 2011; 21: 1081-1125. [DOI:10.1089/thy.2011.0087]
4. Yamamoto T, Amino N, Tanizawa O, Doi K, Ichihara K, Azukizawa M, et al. Longitudinal study of serum thyroid hormones, chorionic gonadotrophin and thyrotrophin during and after normal pregnancy. Clin Endocrinol (Oxf) 1979; 10: 459-468. [DOI:10.1111/j.1365-2265.1979.tb02102.x]
5. Glinoer D, de Nayer P, Bourdoux P, Lemone M, Robyn C, van Steirteghem A, et al. Regulation of maternal thyroid function during pregnancy. J Clin Endocrinol Metab 1990; 71: 276-287. [DOI:10.1210/jcem-71-2-276]
6. Ramezani Tehrani F, Tohidi M, Rostami Dovom M, Azizi F. A Population Based Study on the Association of Thyroid Status with Components of the Metabolic Syndrome. Diabete Metab 2011; 2: 1-5.
7. Azizi F, Delshad H. Thyroid Derangements in Pregnancy. IJEM 2014; 15: 491-508.
8. Cignini p, Cafà EV, Giorlandino C, Capriglione S, Spata A, Dugo N. Thyroid physiology and common diseases in pregnancy: review of literature. J Prenat Med 2012; 6: 64-71.
9. Casey B, Leveno K. Thyroid disease in pregnancy. Obstet Gynecol 2006; 108: 1283-1292. [DOI:10.1097/01.AOG.0000244103.91597.c5]
10. Cunningham F, Leveno KJ, Bloom SL, Hauth JC, Rouse Dj, Spong CY. Williams Obstetrics. 23rd Ed. McGrraw-Hill Companies; 2010.
11. Delshad, H, Azizi, F. Thyroid and pregnancy. J Med Council Iran 2008; 26: 392-408.
12. Banerjee S. Thyroid Disorders in Pregnancy. JAPI 2011; 59: 32-34.
13. Glinoer D, Spencer CA. Serum TSH determinations in pregnancy: how, when and why? Nat Rev Endocrinol 2010; 6: 526-529. [DOI:10.1038/nrendo.2010.91]
14. Lazarus JH. Thyroid function in pregnancy. Br Med Bul 2011; 97: 137-148. [DOI:10.1093/bmb/ldq039]
15. El Baba KA, Azar ST. Thyroid dysfunction in pregnancy. Int J Gen Med 2012; 5: 227-230.
16. Gaberšček S, Zaletel K. Thyroid physiology and autoimmunity in pregnancy and after delivery. Expert Rev Clin Immunol 2011; 7: 697-706. [DOI:10.1586/eci.11.42]
17. Polak M, Le Gac I, Vuillard E, Guibourdenche J, Leger J, Toubert ME, et al. Fetal and neonatal thyroid function in relation to maternal Gravesʼ disease. Best Pract Res Clin Endocrinol Metab 2004; 18: 289-302. [DOI:10.1016/j.beem.2004.03.009]
18. Peleg D, Cada S, Peleg A, Ben-Ami M. The relationship between maternal serum Thyroid-stimulating immunoglobulin and fetal and neonatal thyrotoxicosis. Obstet Gynecol 2002; 99: 1040-1043.
19. Casey BM, Dashe JS, Wells CE, McIntire DD, Leveno KJ, Cunningham FG. Subclinical hyperthyroidism and pregnancy outcomes. Obstet Gynecol 2006; 107: 337-341. [DOI:10.1097/01.AOG.0000197991.64246.9a]
20. Davis LE, Lucas MJ, Hankins GD, Roark ML, Cunningham FG. Thyrotoxicosis complicating pregnancy. Am J Obstet Gynecol 1989; 160: 63-70. [DOI:10.1016/0002-9378(89)90088-4]
21. Kriplani A, Buckshee K, Bhargava VL, Takkar D, Ammini AC. Maternal and perinatal outcome in thyrotoxicosis complicating pregnancy. Eur J Obstet Gynecol Reprod Biol 1994; 54: 159-163. [DOI:10.1016/0028-2243(94)90276-3]
22. Millar LK, Wing DA, Leung AS, Koonings PP, Montoro MN, Mestman JH. Low birth weight and preeclampsia in pregnancies complicated by hyperthyroidism. Obstet Gynecol 1994; 84: 946-949.
23. Phoojaroenchanachai M, Sriussadaporn S, Peerapatdit T, Vannasaeng S, Nitiyanant W, Boonnamsiri V, et al. Effect of maternal hyperthyroidism during late pregnancy on the risk of neonatal low birth weight. Clin Endocrinol (Oxf) 2001; 54: 365-370. [DOI:10.1046/j.1365-2265.2001.01224.x]
24. Luton D, Le Gac I, Vuillard E, Castanet M, Guibourdenche J, Noel M, et al. Management of Graves' disease during pregnancy: the key role of fetal thyroid gland monitoring. J Clin Endocrinol Metab 2005; 90: 6093-6098. [DOI:10.1210/jc.2004-2555]
25. Luewan S, Chakkabut P, Tongsong T. Outcomes of pregnancy complicated with hyperthyroidism: a cohort study. Arch Gynecol Obstet 2011; 283: 243-247. [DOI:10.1007/s00404-010-1362-z]
26. Männistö T, Mendola P, Grewal J, Xie Y, Chen Z, Laughon SK. Thyroid diseases and adverse pregnancy outcomes in a contemporary US cohort. J Clin Endocrinol Metab 2013; 98: 2725-2733. [DOI:10.1210/jc.2012-4233]
27. Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab 2006; 91: 2587-2591. [DOI:10.1210/jc.2005-1603]
28. Negro R, Mestman JH. Thyroid disease in pregnancy. Best Pract Res Clin Endocrinol Metab 2011; 25: 927-943. [DOI:10.1016/j.beem.2011.07.010]
29. Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol 2005; 105: 239-245. [DOI:10.1097/01.AOG.0000152345.99421.22]
30. Vanderpump MPJ. The epidemiology of thyroid disease. Br Med Bulletin 2011; 99: 39-51. [DOI:10.1093/bmb/ldr030]
31. Wilson KL, Casey BM, McIntire DD, Halvorson LM, Cunningham FG. Subclinical thyroid disease and the incidence of hypertension in pregnancy. Obstet Gynecol 2012; 119: 315-320. [DOI:10.1097/AOG.0b013e318240de6a]
32. Sahu MT, Das V, Mittal S, Agarwal A, Sahu M. Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome. Arch Gynecol Obstet 2010; 281: 215-220. [DOI:10.1007/s00404-009-1105-1]
33. 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. [DOI:10.1097/AOG.0b013e3181788dd7]
34. Vissenberg R, Goddijn M, Mol BW, van der Post JA, Fliers E, Bisschop PH. Thyroid dysfunction in pregnant women: clinical dilemmas. Ned Tijdschr Geneeskd 2012; 56: A5163.
35. Abalovich M, Gutierrez S, Alcaraz G, Maccallini G, Garcia A, Levalle O. Overt and Subclinical Hypothyroidism Complicating Pregnancy. Thyroid 2002; 12: 63-68. [DOI:10.1089/105072502753451986]
36. Idris I, Srinivasan R, Simm A, Page RC. Maternal hypothyroidism in early and late gestation: effects on neonatal and obstetric outcome. Clin Endocrinol 2005; 63: 560-565. [DOI:10.1111/j.1365-2265.2005.02382.x]
37. Wolfberg AJ, Lee-Parritz A, Peller AJ, Lieberman ES. Obstetric and neonatal outcomes associated with maternal hypothyroid disease. J Matern Fetal Neonatal Med 2005; 17: 35-38. [DOI:10.1080/14767050400028642]
38. Hirsch D, Levy S, Nadler V, Kopel V, Shainberg B, Toledano Y. Pregnancy outcomes in women with severe hypothyroidism. Eur J Endocrinol 2013; 169: 313-320. [DOI:10.1530/EJE-13-0228]
39. Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999; 341: 549-555. [DOI:10.1056/NEJM199908193410801]
40. Glinoer D, Soto MF, Bourdoux P, Lejeune B, Delange F, Lemone M, et al. Pregnancy in patients with mild thyroid abnormalities: maternal and neonatal repercussions. J Clin Endocrinol Metab 1991; 73: 421-427. [DOI:10.1210/jcem-73-2-421]
41. Glinoer D, Riahi M, Grün JP, Kinthaert J. Risk of subclinical hypothyroidism in pregnant women with asymptomatic autoimmune thyroid disorders. J Clin Endocrinol Metab 1994; 79: 197-204.
42. Stagnaro-Green A, Chen X, Bogden JD, Davies TF, Scholl TO. The thyroid and pregnancy: a novel risk factor for very preterm delivery. Thyroid 2005; 15: 351-357. [DOI:10.1089/thy.2005.15.351]
43. 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: 985-991. [DOI:10.1530/EJE-08-0953]
44. Karakosta P, Alegakis D, Georgiou V, Roumeliotaki T, Fthenou E, Vassilaki M, et al. Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes. J Clin Endocrinol Metab 2012; 97: 4464-4472. [DOI:10.1210/jc.2012-2540]
45. Stagnaro-Green A. Thyroid antibodies and miscarriage: where are we at a generation later? J Thyroid Res 2011; ID 841949.
46. Negro R, Formoso G, Coppola L, Presicce G, Mangieri T, Pezzarossa A, et al. Euthyroid women with autoimmune disease undergoing assisted reproduction technologies: the role of autoimmunity and thyroid function. J Endocrinol Invest 2007; 30: 3-8. [DOI:10.1007/BF03347388]
47. Pop VJ, Brouwers EP, Vader HL, Vulsma T, van Baar AL, Vijlder JJ. Maternal hypothyroxinaemia during early pregnancy and subsequent child development: a 3-year follow-up study. Clin Endocrinol 2003; 59: 282-288. [DOI:10.1046/j.1365-2265.2003.01822.x]
48. Kooistra L, Crawford S, van Baar AL, Brouwers EP, Pop VJ. Neonatal effects of maternal hypothyroxinemia during early pregnancy. Pediatrics 2006; 117: 161-167. [DOI:10.1542/peds.2005-0227]
49. Henrichs J, Bongers-Schokking JJ, Schenk JJ, Ghassabian A, Schmidt HG, Visser TJ, et al. Maternal Thyroid Function during Early Pregnancy and Cognitive Functioning in Early Childhood: The Generation R Study. J Clin Endocrinol Metab 2010; 95: 4227-4234. [DOI:10.1210/jc.2010-0415]
50. Li Y, Shan Z, Teng W, Yu X, Li Y, Fan Ch, et al. Abnormalities of maternal thyroid function during pregnancy affect neuropsychological development of their children at 25-30 months. Clin Endocrinol 2010; 72: 825-829. [DOI:10.1111/j.1365-2265.2009.03743.x]
51. Ghorbani Behrooz H, Tohidi M, Mehrabi Y, Ghorbani Behrooz E, Tehranidoost Mehdi, Azizi F. Subclinical Hypothyroidism in Pregnancy: Intellectual Development of Offspring. Thyroid 2012; 21; 1143-1147. [DOI:10.1089/thy.2011.0053]
52. Liu H, Momotani N, Noh JY, Ishikawa N, Takebe K, Ito K. Maternal hypothyroidism during early pregnancy and intellectual development of the progeny. Arch Intern Med 1994; 154: 785-787. [DOI:10.1001/archinte.1994.00420070109012]
53. Chevrier J, Harley KG, Kogut K, Holland N, Johnson C, Eskenazi B. Maternal Thyroid Function during the Second Half of Pregnancy and Child Neurodevelopment at 6, 12, 24, and 60Months of Age. J Thyroid Res 2011; ID 426427.
54. Downing S, Halpern L, Carswell J, Brown RS. Neuropsychological Development in Children of Mothers with Hypothyroidism Is Normal When Euthyroidism Is Achieved after Conception. Clin Thyroid 2012; 24: 4-8.
55. Momotani N, Iwama S, Momotani K. Neurodevelopment in children born to hypothyroid mothers restored to normal thyroxine (T4) concentration by late pregnancy in Japan: no apparent influence of maternal T4 deficiency. J Clin Endocrinol Metab 2012; 97: 1104-1108. [DOI:10.1210/jc.2011-2797]
56. van den Boogaard E, Vissenberg R, Land JA, van Wely M, van der Post JA, Goddijn M, et al. Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review. Hum Reprod Update 2011; 17: 605-619. [DOI:10.1093/humupd/dmr024]
57. 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 2011; 21: 1081-1125. [DOI:10.1089/thy.2011.0087]
58. Kahric-Janicic N, Soldin SJ, Soldin OP, West T, Gu J, Jonklaas J. Tandem mass spectrometry improves the accuracy of free thyroxine measurements during pregnancy. Thyroid 2007; 17: 303-311. [DOI:10.1089/thy.2006.0303]
59. Bagis T, Gokcel A, Saygili ES. Autoimmune thyroid disease in pregnancy and the postpartum period: relationship to spontaneous abortion. Thyroid 2001; 11: 1049-1053. [DOI:10.1089/105072501753271743]
60. Dendrinos S, Papasteriades C, Tarassi K, Christodoulakos G, Prasinos G, Creatsas G. Thyroid autoimmunity in patients with recurrent spontaneous miscarriages. Gynecol Endocrinol 2000; 14: 270-274. [DOI:10.3109/09513590009167693]
61. Nambiar V, Jagtap VS, Sarathi V, Lila AR, Kamalanathan S, Bandgar TR, et al. Prevalence and Impact of Thyroid Disorders on Maternal Outcome in Asian-Indian PregnantWomen. J Thyroid Res 2011; 1: ID 429097.
62. Kutteh WH, Yetman DL, Carr AC, Beck LA, Scott RT Jr. Increased prevalence of antithyroid antibodies identified in women with recurrent pregnancy loss but not in women undergoing assisted reproduction. Fertil Steril 1999; 71: 843-848. [DOI:10.1016/S0015-0282(99)00091-6]
63. Bussen S, Steck T. Thyroid autoantibodies in euthyroid non-pregnant women with recurrent spontaneous abortions. Hum Reprod 1995; 10: 2938-2940. [DOI:10.1093/oxfordjournals.humrep.a135823]
64. Pratt D, Novotny M, Kaberlein G, Dudkiewicz A, Gleicher N. Antithyroid antibodies and the association with non-organ-specific antibodies in recurrent pregnancy loss. Am J Obstet Gynecol 1993; 168: 837-884. [DOI:10.1016/S0002-9378(12)90830-3]
65. Ashoor G, Maiz N, Rotas M, Jawdat F, Nicolaides KH. Maternal thyroid function at 11-13 weeks of gestation and spontaneous preterm delivery. Obstet Gynecol 2011; 117: 293-298. [DOI:10.1097/AOG.0b013e318205152c]
66. Muller AF, Verhoeff A, Mantel MJ, Berghout A. Thyroid autoimmunity and abortion: a prospective study in women undergoing in vitro fertilization. Fertil Steril 1999; 71: 30-34. [DOI:10.1016/S0015-0282(98)00394-X]
67. Ghassabian A, Tiemeier H. Is measurement of maternal serum TSH sufficient screening in early pregnancy? A case for more randomized trials. Clin Endocrinol (Oxf) 2012; 77: 802-805. [DOI:10.1111/j.1365-2265.2012.04494.x]
68. Stagnaro-Green A, Roman SH, Cobin RH, el-Harazy E, Alvarez-Marfany M, Davies TF. Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. JAMA 1990; 264: 1422-1425. [DOI:10.1001/jama.1990.03450110068029]
69. Singh A, Dantas ZN, Stone SC, Asch RH. Presence of thyroid antibodies in early reproductive failure: biochemical versus clinical pregnancies. Fertil Steril 1995; 63: 277-281. [DOI:10.1016/S0015-0282(16)57355-5]
70. Iijima T, Tada H, Hidaka Y, Mitsuda N, Murata Y, Amino N. Effects of autoantibodies on the course of pregnancy and fetal growth. Obstet Gynecol 1997; 90: 364-369. [DOI:10.1016/S0029-7844(97)00283-4]
71. Poppe K, Glinoer D, Tournaye H, Devroey P, van Steirteghem A, Kaufman L, et al. Assisted reproduction and thyroid autoimmunity: an unfortunate combination. J Clin Endocrinol Metab 2003; 88: 4149-4152. [DOI:10.1210/jc.2003-030268]
72. Marai I, Carp H, Shai S, Shabo R, Fishman G, Shoenfeld Y. Autoantibody panel screening in recurrent miscarriages. Am J Reprod Immunol 2004; 51: 235-240. [DOI:10.1111/j.1600-0897.2004.00153.x]
73. Ghafoor F, Mansoor M, Malik T, Malik MS, Khan AU, Edwards R, et al. Role of thyroid peroxidase antibodies in the outcome of pregnancy. J Coll Physicians Surg Pak 2006; 16: 468-471.
74. Iravani AT, Saeedi MM, Pakravesh J, Hamidi S, Abbasi M. Thyroid autoimmunity and recurrent spontaneous abortion in Iran: a case-control study. Endocrine Practice 2008; 14: 458-464. [DOI:10.4158/EP.14.4.458]
75. Männistö T, Vääräsmäki M, Pouta A, Hartikainen AL, Ruokonen A, Surcel HM, et al. Perinatal outcome of children born to mothers with thyroid dysfunction or antibodies: a prospective populationbased cohort study. J Clin Endocrinol Metab 2009; 94: 772-779 [DOI:10.1210/jc.2008-1520]
76. Soltanghoraee H, Arefi S, Mohammadzadeh A, Taheri A, Zeraati H, Hashemi SB, et al. Thyroid autoantibodies in euthyroid women with recurrent abortions and infertility. Iran J Reprod Med 2010; 8: 153-156.
77. Haddow JE, Cleary-Goldman J, McClain MR, Palomaki GE, Neveux LM, Lambert-Messerlian G, et al. Thyroperoxidase and thyroglobulin antibodies in early pregnancy and preterm delivery. Obstet Gynecol 2010; 116: 58-62. [DOI:10.1097/AOG.0b013e3181e10b30]
78. Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Thyroid antibody positivity in the first trimester of pregnancy is associated with negative pregnancy outcomes. J Clin Endocrinol Metab 2011; 96: 920-924. [DOI:10.1210/jc.2011-0026]

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Designed & Developed by : Yektaweb