scholarly journals Beneficial Effects on Pregnancy Outcomes of Thyroid Hormone Replacement for Subclinical Hypothyroidism

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Norman J. Blumenthal ◽  
Creswell J. Eastman
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Overt Hypothyroidism ◽  
Thyroid Antibodies ◽  
Thyroxine Replacement ◽  
Adverse Pregnancy ◽  
Thyroxine Replacement Therapy ◽  
Serum Tsh

Background. Hypothyroidism and raised thyroid antibody levels have been associated with adverse obstetrical outcomes. Several studies have investigated causal associations, but results have been inconsistent and few studies have reported the effects of thyroxine replacement therapy on pregnancy outcomes in hypothyroid patients.Objective. The primary study objective was to determine the outcome of pregnancies in women diagnosed with overt and subclinical hypothyroidism (SCH) (serum TSH > 2.5 mIU/L) and those with elevated circulating thyroid autoantibody levels in the first trimester of pregnancy and after the institution of appropriate thyroxine replacement therapy to maintain the serum TSH ≤ 2.5 mIU/L.Study Design. This prospective observational study was undertaken between 2013 and 2016. Blood samples were taken from 1025 women at presentation for thyroid stimulating hormone (TSH), anti-thyroglobulin antibodies (TGAb), and thyroid peroxidase antibodies (TPOAb). Those with a TSH > 2.5 mIU/L were treated with thyroxine and managed appropriately to ensure that the TSH was maintained ≤2.5 mIU/L. Outcomes in these patients were compared to those in euthyroid patients. Maternal antenatal complications and perinatal outcomes were recorded.Results. There were a total of 1025 patients of whom 382 (37.5%) were nulliparous. 10.1% had a TSH level > 2.5 mIU/L and 18.2% had at least one raised thyroid antibody level. No differences in adverse outcomes of pregnancy were evident in women treated for SCH or overt hypothyroidism compared to the euthyroid group. There was also no association between raised thyroid antibodies and adverse pregnancy outcomes in either group.Conclusion. There were no adverse outcomes of pregnancy found in pregnant women who had been diagnosed and treated with thyroxine for SCH at the time of presentation when compared to euthyroid patients. There was also no relationship with thyroid antibodies and adverse pregnancy outcomes in the two groups. It is not possible to unequivocally advocate for thyroxine replacement in pregnant women with subclinical and overt hypothyroidism until large scale randomized controlled trials are performed.

scholarly journals Prevalence of sub clinical hypothyroidism and pregnancy outcome: a prospective comparative study

2020 ◽  
Vol 9 (3) ◽  
pp. 1250
Author(s):  
Bilal Ur Rehman ◽  
Hiba Gull
Keyword(s):  
Comparative Study ◽  
Pregnant Women ◽  
Pregnancy Outcome ◽  
Subclinical Hypothyroidism ◽  
Apgar Score ◽  
Adverse Pregnancy Outcome ◽  
Significant Risk ◽  
Overt Hypothyroidism ◽  
Prospective Comparative Study ◽  
Adverse Pregnancy

Background: In pregnancy, subclinical hypothyroidism is more common than overt hypothyroidism, ranging from 15% to 28% in Iodine sufficient region. Evidence suggests that subclinical hypothyroidism is associated with adverse pregnancy outcome. The aim of this study was to find the prevalence of subclinical hypothyroidism in pregnant women and adverse pregnancy outcome.Methods: This hospital based prospective comparative study was conducted over a period of 6 months from 1st July 2018 to 31st December 2018 in department of obstetrics and gynecology SKIMS Soura Kashmir. All the subjects who fulfilled the inclusion criteria and who consented to participate were screened for subclinical hypothyroidism.Results: A total of 175 pregnant women participated in the study and subclinical hypothyroidism was diagnosed in 25 pregnant women (14.2%). Most of our patients were in age group 21 to 30 years (69.1%). Pregnant women with subclinical hypothyroidism had significant risk of preeclampsia (35%) and higher cesarean section rate (29.6%). Neonate of women with subclinical hypothyroidism had higher incidence poor Apgar score, NICU admission.Conclusions: The prevalence of subclinical hypothyroidism is high in pregnant women and the gravity of the complications like pre-eclampsia, neonate with low Apgar score, increased NICU admission, overweight the cost of screening. In this view, we propose screening of all pregnant women in the first trimester for diagnosis.

scholarly journals Effectiveness of Prenatal Vitamin D Deficiency Screening and Treatment Program: A Stratified Randomized Field Trial

2018 ◽  
Vol 103 (8) ◽  
pp. 2936-2948 ◽  
Author(s):  
Maryam Rostami ◽  
Fahimeh Ramezani Tehrani ◽  
Masoumeh Simbar ◽  
Razieh Bidhendi Yarandi ◽  
Sonia Minooee ◽  
...  
Keyword(s):  
Vitamin D ◽  
Pregnant Women ◽  
Treatment Program ◽  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Screening Program ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Adverse Pregnancy ◽  
Screening Site

Abstract Context Despite evidence on the association between hypovitaminosis D and adverse pregnancy outcomes and the positive impact of vitamin D supplementation, no evidence exists supporting a universal screening program in pregnancy as part of routine prenatal care. Objective We sought to determine the effectiveness of a prenatal screening program on optimizing 25-hydroxyvitamin D [25(OH)D] levels and preventing pregnancy complications. Also, to identify a safe regimen, we compared several regimens in a subgroup of vitamin D–deficient pregnant women. Design Two cities of Masjed-Soleyman and Shushtar from Khuzestan province, Iran, were selected as the screening and nonscreening arms, respectively. Within the screening arm, a randomized controlled trial was conducted on 800 pregnant women. Setting Health centers of Masjed-Soleyman and Shushtar cities. Patients or Participants Pregnant women aged 18 to 40 years. Intervention Women with moderate [25(OH)D, 10 to 20 ng/mL] and severe [25(OH)D, <10 ng/mL] deficiency were randomly divided into four subgroups and received vitamin D3 (D3) until delivery. Main Outcome Measure Maternal concentration of 25(OH)D at delivery and rate of pregnancy complications Results After supplementation, only 2% of the women in the nonscreening site met the sufficiency level (>20 ng/mL) vs 53% of the women in the screening site. Adverse pregnancy outcomes, including preeclampsia, gestational diabetes mellitus, and preterm delivery, were decreased by 60%, 50%, and 40%, respectively, in the screening site. A D3 injection in addition to monthly 50,000 IU maintenance therapy contributed the most to achievement of sufficient levels at delivery. Conclusions A prenatal vitamin D screening and treatment program is an effective approach in detecting deficient women, improving 25(OH)D levels, and decreasing pregnancy adverse outcomes.

scholarly journals Alterations in Vaginal Microbiota among Pregnant Women with COVID-19

2021 ◽  
Author(s):  
Ebru Celik ◽  
Gulin Ozcan ◽  
Cansel Vatansever ◽  
Erxiati Paerhati ◽  
Mert Ahmet Kuskucu ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Diversity Index ◽  
Alpha Diversity ◽  
Active Phase ◽  
Adverse Outcomes ◽  
Vaginal Microbiota ◽  
Rrna Gene ◽  
Increased Risk ◽  
Adverse Pregnancy

Abstract Background: The maintenance of vaginal microbiota is an important factor to achieve ideal pregnancy outcomes. Coronavirus disease (COVID-19) has been shown to have potential adverse effects on pregnancy and neonatal outcomes. Pregnancy itself is a risk factor for the severity of COVID-19, with an increased risk of intensive care unit (ICU) admission, maternal morbidity, and mortality. the role of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in vaginal microbiome composition in pregnant women with COVID-19 has not yet been investigated. Therefore, we anticipate that COVID-19 may unfavorably affect the composition of the vaginal microbiota, resulting in adverse pregnancy outcomes. We aimed to describe the alterations of the composition of vaginal microbiota in pregnant women with COVID-19.Results: A prospective case-control study was conducted among 19 pregnant women with COVID-19 and 28 healthy controls matched according to the gestational week and age. The vaginal swabs were collected during the active phase of infection and consecutively, within a month after recovering from infection. In three patients, longitudinal samples before, in the course, and after infection were also obtained. The microbiome alterations were examined by 16S rRNA gene sequencing. We indicated that COVID-19 was associated with vaginal dysbiosis during pregnancy, which was indicated by an increased alpha diversity index. There was a significantly decrease in Firmicutes (P=0.007) and Lactobacillus (P=0.019) with an increase in Bacteroidetes (P=0.024) in the COVID-19 group. In the moderate/severe group, increased amounts of Ureaplasma and vanishing of Lactobacillus gasseri were found in women, compared to the asymptomatic or mild group (P=0.001). In longitudinal analysis, elevation of Actinobacteria with reduction of Firmicutes and Bacteroides were indicated during the active phase. Conclusions: The study revealed vaginal dysbiosis with a low abundance of Lactobacillus and an increase in Bacteroidetes in relation to SARS-CoV-2 infection. Vaginal dysbiosis in COVID-19 could be a contributing factor in pregnancy adverse outcomes. Trial registration: clinicaltrials, Registered 15 November 2019, https://www.clinicaltrials.gov/ct2/show/NCT04165252?cond=microbiota&cntry=TR&draw=3&rank=12

scholarly journals Pregnancy outcomes among women with thyrotoxicosis a retrospective cohort study

2021 ◽  
Author(s):  
Panwad Harn-a-morn ◽  
Prapai Dejkhamron ◽  
Theera Tongsong ◽  
Suchaya Luewan
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Obstetric Outcomes ◽  
Study Group ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
Singleton Pregnancies

Abstract Objective: To compare adverse outcomes between: 1) pregnant women with thyrotoxicosis and low risk pregnancies, 2) pregnant women with thyrotoxicosis requiring no anti-thyroid drug (ATD) and low risk pregnancies, and 3) those treated with methimazole (MMI) and propylthiouracil (PTU)Methods: The medical records of singleton pregnancies with thyrotoxicosis were comprehensively reviewed. Low-risk pregnancies matched for age and parity were randomly recruited as controls. The obstetric outcomes were compared between both groups, and the outcomes of various subgroups of the study group were also compared.Results: A total of 408 pregnant women with thyrotoxicosis were recruited. Compared with the controls, the women of the study group had significantly higher rates of low birth weight (LBW) (23.7% vs 17.7%; p:0.036), preterm birth (19.3% vs 12.3%; p:0.007), preeclampsia (8.5% vs 4.4%; p: 0.019) and cesarean section (21.5% vs 16.0%; p:0.046). In the study group (thyrotoxicosis), 67, 127, and 158 patients were treated with MMI, PTU and no anti-thyroid drug (ATD), respectively. All obstetric outcomes were comparable between the women treated with PTU and those with MMI, and between the controlled and uncontrolled groups. However, women who needed ATD had significantly higher rates of LBW and preterm birth than those without medications.Conclusions: Thyrotoxicosis, whether treated or not needing ATDs, was significantly associated with an increased risk of adverse pregnancy outcomes. Also, active disease, indicated by the need for ATD significantly increased the risk of such adverse outcomes, whereas the patients treated with MMI or PTU had comparable adverse outcomes.

scholarly journals Strategies for the prevention of malaria in pregnancy in Indonesia in the COVID-19 pandemic era

2020 ◽  
Vol 7 (7) ◽  
pp. 2862
Author(s):  
Andre Prawira-Putra ◽  
Theda Lukito ◽  
Rukhsana Ahmed
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Vulnerable Group ◽  
Public Health Burden ◽  
The Public ◽  
Health Burden ◽  
Infant Morbidity ◽  
Adverse Pregnancy ◽  
In Pregnancy

Malaria is one of the oldest infectious disease that continues to affect annually more than 200 million people globally. Pregnant women are the second most vulnerable group to malaria, besides children. A pregnant woman with malaria risks detrimental harm to herself and to her child resulting in adverse pregnancy outcomes. These adverse outcomes contribute to maternal, neonatal and infant morbidity and mortality. It is essential to protect pregnant women from malaria to improve the public health burden in malaria endemic countries.

scholarly journals Incidence and pattern of infections in pregnant women with bad obstetric history

2021 ◽  
Vol 10 (10) ◽  
pp. 3846
Author(s):  
N. Swetha Goud ◽  
M. Manasa Reddy ◽  
Savitha Desai
Keyword(s):  
Bacterial Vaginosis ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Sensorineural Deafness ◽  
Adverse Outcomes ◽  
Gram Stain ◽  
Varicella Zoster ◽  
Obstetric History ◽  
Adverse Pregnancy ◽  
Amsel Criteria

Background: Adverse outcomes have been seen in pregnant women who had prior bad obstetric history along with infection with TORCH [toxoplasma, other infections (syphilis, varicella zoster, hepatitis B), rubella, cytomegalovirus, herpes simplex]complex and bacterial vaginosis. These infections are known to affect the health of the fetus. Objective was to study incidence and pattern of infections in pregnant women with bad obstetric history.Methods: A total of 190 patients with bad obstetric history fulfilling the methodology criteria were evaluated. Serological and molecular evaluations were carried out for TORCH complex and bacterial vaginosis was detected by both gram stain and gold standard clinical Amsel criteria and outcomes were followed.Results: Out of 190 pregnant women with bad obstetric history, a total of 36 (18.8%) were detected to have infections causing bad obstetric history. Toxoplasma was positive in 7 (20%) of the cases, 3 (51.92%) of them had abortions. Rubella in 12 (32%) of the cases, 7 (60%) cases had sensorineural deafness. Cytomegalovirus in 1 (2%) of the cases, 1 (100%) of the case had microcephaly. Herpes in 8 (22%) cases, 6 (71.1%) cases had abortions. Bacterial vaginosis in 8 (22%) of the cases, 4 (48.6%) cases had preterm delivery. The presence of infections with TORCH complex and bacterial vaginosis was related to adverse pregnancy outcomes.Conclusions: Women with bad obstetric history are prone to infections during pregnancy and have been found out to be associated with adverse pregnancy outcomes. Hence pregnant women should be screened so that early diagnosis and treatment of infections can be done to have better pregnancy outcomes.

The Effect of Treated Overt Hypothyroidism on Outcomes in Twin Pregnancies

2017 ◽  
Vol 34 (14) ◽  
pp. 1447-1450
Author(s):  
Nathan Fox ◽  
Daniel Saltzman ◽  
Andrei Rebarber ◽  
Simi Gupta ◽  
Jonathan Rosner
Keyword(s):  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Overt Hypothyroidism ◽  
Thyroid Function Tests ◽  
Spontaneous Preterm Birth ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
Twin Pregnancies

Objective The objective of this study was to determine if treatment of overt hypothyroidism in twin pregnancies reduces adverse outcomes associated with overt hypothyroidism in pregnancy. Methods This is a retrospective cohort study of all patients who were presented with twin gestations between 2005 and 2013 to a single obstetrical practice. Patients who were diagnosed with overt hypothyroidism were identified. Patients were followed up with serial thyroid function tests and treated appropriately. Rates of adverse pregnancy outcomes were compared between patients with and without hypothyroidism with p < 0.05 used for significance. Results In this study, 612 twin pregnancies were included; 85 patients were diagnosed with overt hypothyroidism. Patients with overt hypothyroidism were more likely to have had in vitro fertilization (78 vs. 62%; p < 0.01). After adjusting for confounding variables, patients with overt hypothyroidism had no increased risk of spontaneous preterm birth < 37 weeks' gestation (adjusted odds ratio [aOR]: 0.833; 95% confidence interval [CI]: 0.498–1.393), intrauterine growth restriction (aOR: 0.720; 95% CI: 0.446–1.163), gestational diabetes (aOR: 0.812; 95% CI: 0.353–1.871), or composite adverse outcomes (aOR: 0.659; 95% CI 0.391–1.111) compared with patients who did not have overt hypothyroidism. There was a trend toward decreased hypertensive disorders of pregnancy (aOR: 0.470; 95% CI: 0.234–0.944). Conclusion Our study shows that in twin gestations, there is no increased risk of adverse pregnancy outcomes between patients with treated overt hypothyroidism and those without overt hypothyroidism.

scholarly journals Lipid Characteristics of Pregnant Women With Subclinical Hypothyroidism and Their Correlation to the Pregnancy Outcomes

2021 ◽  
Author(s):  
Jingjing Li ◽  
Yajuan Xu ◽  
Zongzong Sun ◽  
Yanjun Cai ◽  
Biao Wang ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Pregnancy Outcomes ◽  
Metabolic Pathways ◽  
Enrichment Analysis ◽  
Control Group ◽  
Pathway Enrichment Analysis ◽  
Adverse Pregnancy ◽  
Factor Α ◽  
In Pregnancy

Abstract Subclinical hypothyroidism (SCH) in pregnancy has become an important complication of pregnancy. We used nontargeted lipidomics to compare differential metabolites between women with SCH and healthy women. The metabolic pathways of the differential metabolites were analyzed using the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. We found: 1. Multivariate analysis revealed 143 lipid molecules with different levels between the SCH group and the control group. Based on fold change, 30 differential lipid metabolites were selected as potential biomarkers. 2. KEGG pathway enrichment analysis showed that the differential metabolites participate in such pathways as pathogenic Escherichia coli infection response, metabolic pathways, glycerophospholipid metabolism. 3. Correlation analysis showed that sphingomyelin (SM) and phosphatidylcholine (PC) were positively correlated with tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and interleukin-6 (IL-6), while phosphatidylglycerol (PG), and phosphatidylinositol (PI) were negatively correlated with them. And PG was positively correlated with birth weight. The lipid profile of pregnant women with SCH is significantly different from that of healthy pregnant women. Lipid molecules with differential metabolism, such as SM, PE, and PI, might be targets for further investigation of the pathogenesis of SCH in pregnancy and reduce the incidence of adverse pregnancy outcomes.

scholarly journals A hospital based retrospective study of thyroid disorders on obstetric and perinatal outcomes

2020 ◽  
Vol 9 (11) ◽  
pp. 4590
Author(s):  
Sagar R. Patel ◽  
Pushpa A. Yadava ◽  
Shital T. Mehta ◽  
Bina M. Raval ◽  
Viditsinh P. Sisodiya ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Universal Screening ◽  
Perinatal Outcomes ◽  
Preterm Births ◽  
First Trimester ◽  
Adverse Outcomes ◽  
Overt Hypothyroidism ◽  
Thyroid Disorders ◽  
Free T4

Background: The study was undertaken in pregnant women to understand and analyze the obstetric and foetal outcomes of thyroid disorders.Methods: TSH estimation was used as universal screening in their first visit to our hospital. Those patients with abnormal TSH values, i.e. above 2.5 mIU/ml in first trimester and above 3 mIU/ml in second and third trimesters were evaluated for free T3, free T4 and TPO Abs. They were treated accordingly and dosage adjustments made and the tests repeated once in 4-6 weeks. They were followed throughout pregnancy and delivery.Results: Total no of pregnant women screened were 904 over a period of 1 year from 15 March 2019 to 14 March 2020, of which 115 had abnormal thyroid functions, thereby the prevalence of thyroid disorders being 12.72%. Of the 115 patients with thyroid disorders, 112 were hypothyroid and 3 were hyperthyroid. Among the 112 hypothyroid cases, 48 were known cases and 64 were new cases. The total cases of subclinical hypothyroidism were 88, prevalence being 9.73% and overt cases were 24, prevalence being 2.65%; 3 cases were overt hyperthyroid, prevalence being 0.33%. 66% of subclinical hypothyroidism were TPO positive and 34% of overt hypothyroidism were TPO positive (p<0.05). Out of 115 abnormal thyroid function patients, 92 patients delivered in our hospital. There were 15 abortions, 13 spontaneous and 2 terminations of pregnancies; 7 patients have delivered outside and 1 patient lost follow up.Conclusions: The prevalence of thyroid disorders during pregnancy was significantly more in our study, hypothyroidism being the commonest. Significant numbers of cases were newly diagnosed on universal screening. The commonest disorder was subclinical hypothyroidism. Adverse maternal and foetal outcomes were almost similar in both subclinical and overt hypothyroidism. The common adverse outcomes noted were abortions, pre-eclampsia, gestational diabetes mellitus, preterm births and increased rates of caesarean sections. The adverse outcomes were significantly more in autoimmune antibody positive patients.

scholarly journals Pregnancy Outcomes among Women with Graves’ Hyperthyroidism: A Retrospective Cohort Study

2021 ◽  
Vol 10 (19) ◽  
pp. 4495
Author(s):  
Panwad Harn-a-morn ◽  
Prapai Dejkhamron ◽  
Theera Tongsong ◽  
Suchaya Luewan
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Obstetric Outcomes ◽  
Increased Risk ◽  
Adverse Pregnancy

Objective: The primary objectives of this study are to compare the rates of preterm birth; fetal growth restriction and low birth weight between the following groups: (1) pregnant women treated for thyrotoxicosis and low-risk pregnancies; (2) between pregnant women with thyrotoxicosis with no need of medication and low-risk pregnancies; and (3) between those treated with MMI and PTU. Methods: The medical records of singleton pregnancies with thyrotoxicosis were comprehensively reviewed. Low-risk pregnancies matched for age and parity were randomly recruited as controls. The obstetric outcomes were compared between both groups; the outcomes of various subgroups of the thyrotoxicosis group were also compared. Results: A total of 408 pregnant women with thyrotoxicosis were recruited. Compared with the controls; the women of the thyrotoxicosis group had significantly higher rates of low birth weight (LBW) (23.7% vs. 17.7%; p: 0.036), preterm birth (19.3% vs. 12.3%; p: 0.007), preeclampsia (8.5% vs. 4.4%; p: 0.019) and cesarean section (21.5% vs. 16.0%; p: 0.046). In the thyrotoxicosis group; 67; 127; and 158 patients were treated with MMI; PTU and no anti-thyroid drug (ATD), respectively. All obstetric outcomes were comparable between the women treated with PTU and those with MMI; and between the controlled and uncontrolled groups. However, women who needed ATD had significantly higher rates of LBW and preterm birth than those without medications. Conclusions: Thyrotoxicosis, whether treated or not needing ATDs, was significantly associated with an increased risk of adverse pregnancy outcomes. Also, active disease, indicated by the need for ATD significantly increased the risk of such adverse outcomes; whereas the patients treated with MMI or PTU had comparable adverse outcomes.

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