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Haridas K, Sasaki T, Leung AM. Evaluation and Management of Thyrotoxicosis During Pregnancy. Endocrinol Metab Clin North Am 2024; 53:349-361. [PMID: 39084812 DOI: 10.1016/j.ecl.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
This review summarizes the diagnosis and management of thyrotoxicosis in pregnancy. The diagnostic clinical and biochemical considerations used to distinguish the various etiologies of hyperthyroidism from appropriate physiologic changes during pregnancy will be outlined. Finally, the review will discuss the risks and benefits of available options for the treatment of thyrotoxicosis during pregnancy, to mitigate the risks of fetal hyperthyroidism.
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Affiliation(s)
- Keerthana Haridas
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard (111D), Los Angeles, CA 90073, USA
| | - Tamlyn Sasaki
- University of Hawaii John A. Burns School of Medicine, 651 Ilalo Street, Medical Education Building, 3rd Floor, Honolulu, HI 96813, USA
| | - Angela M Leung
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard (111D), Los Angeles, CA 90073, USA.
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2
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Chaker L, Cooper DS, Walsh JP, Peeters RP. Hyperthyroidism. Lancet 2024; 403:768-780. [PMID: 38278171 DOI: 10.1016/s0140-6736(23)02016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/07/2023] [Accepted: 09/16/2023] [Indexed: 01/28/2024]
Abstract
Thyrotoxicosis causes a variety of symptoms and adverse health outcomes. Hyperthyroidism refers to increased thyroid hormone synthesis and secretion, most commonly from Graves' disease or toxic nodular goitre, whereas thyroiditis (typically autoimmune, viral, or drug induced) causes thyrotoxicosis without hyperthyroidism. The diagnosis is based on suppressed serum concentrations of thyroid-stimulating hormone (TSH), accompanied by free thyroxine and total or free tri-iodothyronine concentrations, which are raised (overt hyperthyroidism) or within range (subclinical hyperthyroidism). The underlying cause is determined by clinical assessment, detection of TSH-receptor antibodies and, if necessary, radionuclide thyroid scintigraphy. Treatment options for hyperthyroidism include antithyroid drugs, radioactive iodine, and thyroidectomy, whereas thyroiditis is managed symptomatically or with glucocorticoid therapy. In Graves' disease, first-line treatment is a 12-18-month course of antithyroid drugs, whereas for goitre, radioactive iodine or surgery are preferred for toxic nodules or goitres. Evidence also supports long-term treatment with antithyroid drugs as an option for patients with Graves' disease and toxic nodular goitre.
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Affiliation(s)
- Layal Chaker
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - David S Cooper
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John P Walsh
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Medical School, University of Western Australia, Crawley, WA, Australia
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.
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3
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Lumchee M, Yue M, Laurie J, Morton A. Therapeutic plasma exchange for Graves' disease in pregnancy. Obstet Med 2023; 16:126-129. [PMID: 37441666 PMCID: PMC10334034 DOI: 10.1177/1753495x211031328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/26/2021] [Accepted: 05/30/2021] [Indexed: 06/04/2024] Open
Abstract
Graves' disease in pregnancy may be associated with maternal, fetal and neonatal complications, which are proportionate to the severity of hyperthyroidism. Optimal management is detailed preconception counselling, achievement of an euthyroid state prior to conception, and close monitoring of thyroid function and thyroid-stimulating antibodies together with judicious use of anti-thyroid medications during pregnancy. A case of Graves' disease in pregnancy, complicated by pancytopenia, with a deterioration in thyroid function following cessation of thionamide therapy is described here. Therapeutic plasma exchange was subsequently used to achieve rapid control prior to thyroidectomy. Therapeutic plasma exchange is an effective treatment for hyperthyroidism where thionamides are ineffective or contraindicated, as a bridge to definitive management.
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Affiliation(s)
- Matthew Lumchee
- Department of Obstetric Medicine, Mater Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Mimi Yue
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Haematology, Mater Hospital, Brisbane, Queensland, Australia
| | - Josephine Laurie
- Department of Obstetric Medicine, Mater Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Adam Morton
- Department of Obstetric Medicine, Mater Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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4
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Guo YC, Lin CY, Lu HY, Zhang L, Ma KSK. Hyperthyroidism in patients with asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:667-668. [PMID: 36759086 DOI: 10.1016/j.jaip.2022.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/22/2022] [Indexed: 02/10/2023]
Affiliation(s)
- Yu-Chen Guo
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China; Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chen-Yu Lin
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China; Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hsin-Yo Lu
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China; Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Liyun Zhang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China; Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Kevin Sheng-Kai Ma
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass.
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Nazarpour S, Ramezani Tehrani F, Amiri M, Rahmati M, Azizi F. Maternal subclinical hyperthyroidism and adverse pregnancy outcomes considering the iodine status: Tehran thyroid and pregnancy study. J Trace Elem Med Biol 2022; 74:127063. [PMID: 36113393 DOI: 10.1016/j.jtemb.2022.127063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/30/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Unlike overt thyroid diseases, the impacts of subclinical thyroid dysfunction, especially subclinical hyperthyroidism (SH), on adverse pregnancy outcomes are inconclusive. OBJECTIVE We aimed to investigate the effect of maternal SH on adverse maternal and neonatal outcomes based on urinary iodine concentration (UIC). METHODS A secondary analysis was run on data collected in the Tehran Thyroid and Pregnancy study (TTPs). We used the data of 131 women with SH and 1650 cases of euthyroid. Serum levels of thyroid-stimulating hormone (TSH), thyroxine (T4), free thyroxine index (FT4I), and thyroid peroxidase antibody (TPOAb) were assessed at the first prenatal visit. A generalized linear regression model was applied to identify the effect of SH on the pregnancy outcomes based on UIC, and the effects were estimated with a 95% confidence interval. RESULTS Preterm delivery was observed in 12.3% of women with SH and 6.7% of those with euthyroid (P = 0.03). Women with TSH< 0.3 mIU/L had a higher odds of preterm delivery than those with TSH≥ 0.3 regardless of urine iodine cut-off [OR= 2.27; 95% CI: (1.15, 4.48), p = 0.02]. Among those with UIC levels≥ 150 μg/L, the odds ratio of preterm delivery was 4.61 folds higher in the SH group compared to those with euthyroid [95%CI: (1.36, 15.71), p = 0.01)]. No significant difference between these two study groups was found in Neonatal Intensive Care Unit admission. Moreover, the results revealed no statistically significant difference in the means of neonatal anthropometric parameters in the SH and euthyroid groups in none of the subgroups of UIC (<150 or ≥150 µg/l). CONCLUSIONS According to our results, maternal SH appears to be a risk factor for preterm delivery. This effect is more pronounced in women with higher UIC than those with lower UIC.
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Affiliation(s)
- Sima Nazarpour
- Department of Midwifery, Varamin-Pishva Branch, Islamic Azad University, Tehran, Iran; Post-doctoral researcher, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Zhang X, Huels A, Makuch R, Zhou A, Zheng T, Xia W, Gaskins A, Makuch J, Zhu Z, Zhu C, Qian Z, Xu S, Li Y. Association of exposure to ambient particulate matter with maternal thyroid function in early pregnancy. ENVIRONMENTAL RESEARCH 2022; 214:113942. [PMID: 35870505 DOI: 10.1016/j.envres.2022.113942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/15/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND It is known that maternal thyroid dysfunction during early pregnancy can cause adverse pregnancy complications and birth outcomes. This study was designed to examine the association between ambient particulate matter with aerodynamic diameters ≤2.5 μm (PM2.5) and particulate matter with aerodynamic diameters ≤10 μm (PM10) exposure and maternal thyroid function during early pregnancy. METHODS This study was based on data from a birth cohort study of 921 pregnant women in China. We estimated associations between ambient PM2.5 and PM10 exposure during the first trimester of pregnancy (estimated with land-use regression models) and maternal thyroid hormone concentrations (free thyroxine (FT4), free tri-iodothyronine (FT3), and thyroid-stimulating hormone (TSH)) collected between weeks 10 and 17 of gestation using linear regression models adjusting for potential confounders. Ambient PM2.5 and PM10 concentrations were modeled per interquartile range (IQR) increment and as tertiles based on the distribution of the exposure levels. RESULTS An IQR increment (68 μg/m3) in PM2.5 exposure was associated with a significant decrease in maternal FT4 levels (β = -0.60, 95% CI: -1.07, -0.12); and a significant decrease in FT4/FT3 ratio (β = -0.13, 95% CI: -0.25, -0.02). Further analyses showed that, relative to the lowest tertile, women in both the middle and highest tertiles of PM2.5 had significantly lower concentrations of maternal FT4 and FT4/FT3 ratio. No significant associations were found between PM2.5 and FT3 or TSH levels. PM10 exposure was not significantly associated with maternal thyroid function. CONCLUSIONS Our study suggested that higher ambient PM2.5, not PM10, exposed during the first trimester of pregnancy were associated with a significant decrease in maternal serum FT4 concentrations and FT4/FT3 ratio. Studies in populations with different exposure levels are needed to replicate our study results.
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Affiliation(s)
- Xichi Zhang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anke Huels
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Robert Makuch
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Aifen Zhou
- Women and Children Medical and Healthcare Center of Wuhan, Wuhan, Hubei, People's Republic of China
| | - Tao Zheng
- Molecular Microbiology and Immunology, Warren Alpert Medical School of Brown University, USA
| | - Wei Xia
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Audrey Gaskins
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jad Makuch
- Department of Ecosystem Science and Policy, University of Miami, Miami, FL, USA.Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO
| | - Zhou Zhu
- Molecular Microbiology and Immunology, Warren Alpert Medical School of Brown University, USA
| | - Cairong Zhu
- Huaxi School of Public Health, Chengdu, Sichuan, China
| | - Zhengmin Qian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, USA
| | - Shunqing Xu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuanyuan Li
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Abstract
Thyroid hormones are primarily responsible for regulating the basal metabolic rate but also make important contributions to reproductive function and fetal development. Both hyper- and hypothyroidism in pregnancy have been associated with increased risks of complications that include preeclampsia and low birth weight, among others. Furthermore, thyroid hormone deficiency in the developing fetus results in neurodevelopmental delay. As the fetus is exclusively reliant on maternal thyroid hormone for most of the first trimester and requires continued maternal supply until birth, identifying maternal thyroid dysfunction is critically important. However, evaluating thyroid function in pregnancy is challenging because of the many physiological changes that affect concentrations of thyroid-related analytes. Increasing plasma human chorionic gonadotropin (hCG) concentrations in the second half of the first trimester elicit a corresponding transient decrease in thyroid-stimulating hormone (TSH), and continually increasing estradiol concentrations throughout pregnancy cause substantial increases in thyroxine-binding globulin (TBG) and total thyroxine (T4) relative to the nonpregnant state. Lastly, free T4 concentrations gradually decrease with increasing gestational age. For these reasons, it is essential to interpret thyroid function test results in the context of trimester-specific reference intervals to avoid misclassification of thyroid status. This review summarizes the effects of thyroid dysfunction prior to conception and during pregnancy and describes considerations for the laboratory assessment of thyroid function in pregnant women.
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Affiliation(s)
- K Aaron Geno
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Robert D Nerenz
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
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Hizkiyahu R, Badeghiesh A, Baghlaf H, Dahan MH. Associations between hyperthyroidism and adverse obstetric and neonatal outcomes: A study of a population database including almost 17,000 women with hyperthyroidism. Clin Endocrinol (Oxf) 2022; 97:347-354. [PMID: 35261044 DOI: 10.1111/cen.14713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/19/2022] [Accepted: 02/24/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Large population-based studies on maternal hyperthyroidism's effect on antepartum, intrapartum, and neonatal complications are few. Most of these studies were small or did not evaluate a broad scope of possible complications. Therefore, a large population-based cohort study was conducted to study the associations between maternal hyperthyroidism and pregnancy and perinatal complications. DESIGN This is a retrospective population-based cohort study utilizing data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample over 11 years from 2004 to 2014. PATIENTS 16,984 deliveries to women with hyperthyroidism and 9,079,804 deliveries to mothers who did not suffer of hyperthyroidism. METHODS A cohort of all deliveries between 2004 and 2014 inclusively was created. Within this group, all deliveries to women with hyperthyroidism were the study group (n = 16,984) and the remaining deliveries were categorized as nonhyperthyroidism births and comprised the reference group (n = 9,079,804). The main outcome measures were pregnancy and perinatal complications. RESULTS Maternal hyperthyroidism was associated with several pregnancy and perinatal complications, including increased risks of gestational hypertension (adjusted odds ratio [aOR]: 1.236, 95% confidence interval [CI]: 1.045-1.462, p = .013) and preeclampsia (aOR: 1.190, 95% CI: 1.006-1.408, p = .042). These patients are more likely to experience preterm premature rupture of membranes (aOR: 1.322, 95% CI: 1.007-1.735, p = .044), preterm delivery (aOR: 1.287 95% CI: 1.132-1.465, p < .001), placental previa (aOR: 1.527, 95% CI: 1.082-2.155, p = .016), and suffer from venous thromboembolism (aOR: 2.894, 95% CI: 1.293-6.475, p = .010). As for neonatal outcomes, small for gestational age and stillbirth were more likely to occur in the offspring of women with hyperthyroidism (aOR: 1.688, 95% CI: 1.437-1.984, p < .001 and aOR: 1.647, 95% CI: 1.109-2.447, p = .013, respectively). CONCLUSIONS Women with hyperthyroidism are more likely to experience pregnancy, delivery, and neonatal complications. We found an association between hyperthyroidism and hypertensive disorders, preterm delivery, and intrauterine fetal death.
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Affiliation(s)
- Ranit Hizkiyahu
- Department of Obstetrics and Gynecology, Mcgill University, Montreal, Québec, Canada
| | - Ahmad Badeghiesh
- Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada
| | - Haitham Baghlaf
- Department of Obstetrics and Gynecology, University of Tabuk, Tabouk, Saudi Arabia
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, Mcgill University, Montreal, Québec, Canada
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Li M, He Y, Mao Y, Yang L, Chen L, Du J, Chen Q, Zhu Q, Liu J, Zhou W. Preconception thyroid-stimulating hormone levels and adverse pregnancy outcomes. Clin Endocrinol (Oxf) 2022; 97:339-346. [PMID: 34951040 DOI: 10.1111/cen.14668] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 11/23/2021] [Accepted: 12/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Evidence for the association between subclinical thyroid dysfunction before conception and its pregnancy outcomes is inconsistent. Thus, we evaluated the relationship between preconception thyroid-stimulating hormone (TSH) levels and adverse pregnancy outcomes. DESIGN Retrospective cohort study. METHODS A total of 50,217 women without prior thyroid disease who became pregnant within 1 year after undertaking a routine TSH test in the Chongqing Municipality of China (2010-2016) were studied. Restricted cubic spline regression and logistic regression were used to estimate the association between preconception TSH levels and pregnancy outcomes. The main outcomes were individual and composite adverse pregnancy outcomes (CAPOs) comprising pregnancy loss, small for gestational age, large for gestational age, and preterm birth. RESULTS Incidence of CAPO was 24.19%. Increased preconception TSH level was positively associated with CAPO (odds ratio [OR]/SD: 1.04, 95% confidence interval [CI]: 1.01-1.07) when TSH was ≥2.1 mIU/L, positively associated with pregnancy loss (OR/SD: 1.06, 95% CI: 1.01-1.12) when TSH was <2.1 mIU/L, negatively and positively associated with preterm delivery when TSH levels were <1.3 mIU/L (OR/SD: 0.90, 95% CI: 0.83-0.97) and >3.0 mIU/L (OR/SD: 1.08, 95% CI: 1.00-1.17), respectively. Women with subclinical hypothyroidism before conception were at a higher risk for CAPO (adjusted odds ratio [aOR]: 1.12, 95% CI: 1.04-1.22), while those with subclinical hyperthyroidism had a higher risk of preterm delivery (aOR: 1.31, 95% CI: 1.01-1.70). CONCLUSIONS Nonlinear associations were indicated between preconception TSH levels and pregnancy outcomes. Subclinical thyroid dysfunction before conception was associated with an increased risk of adverse pregnancy outcomes.
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Affiliation(s)
- Min Li
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Yang He
- NHC Key Laboratory of Birth Defects and Reproductive Health (Chongqing Population and Family Planning Science and Technology Research Institute), Chongqing, China
| | - Yanyan Mao
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Liu Yang
- NHC Key Laboratory of Birth Defects and Reproductive Health (Chongqing Population and Family Planning Science and Technology Research Institute), Chongqing, China
| | - Liang Chen
- NHC Key Laboratory of Birth Defects and Reproductive Health (Chongqing Population and Family Planning Science and Technology Research Institute), Chongqing, China
| | - Jing Du
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Qing Chen
- NHC Key Laboratory of Birth Defects and Reproductive Health (Chongqing Population and Family Planning Science and Technology Research Institute), Chongqing, China
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Qianxi Zhu
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Jun Liu
- NHC Key Laboratory of Birth Defects and Reproductive Health (Chongqing Population and Family Planning Science and Technology Research Institute), Chongqing, China
| | - Weijin Zhou
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
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Nazarpour S, Amiri M, Bidhendi Yarandi R, Azizi F, Ramezani Tehrani F. Maternal Subclinical Hyperthyroidism and Adverse Pregnancy Outcomes: A Systematic Review and Meta-analysis of Observational Studies. Int J Endocrinol Metab 2022; 20:e120949. [PMID: 36425270 PMCID: PMC9675093 DOI: 10.5812/ijem-120949] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Findings from studies evaluating adverse pregnancy outcomes in pregnant women with subclinical hyperthyroidism are conflicting and inconclusive. OBJECTIVES In this systematic review and meta-analysis, our aim was to evaluate the pooled odds ratio (OR) of adverse pregnancy outcomes in women with subclinical hyperthyroidism, compared to euthyroid women. DATA SOURCES Scopus, PubMed (including Medline), and Web of Science databases were systemically searched for regaining published studies to January 2022 examining adverse pregnancy outcomes in women with subclinical hyperthyroidism. STUDY SELECTION Outcomes of interest were classified into seven composite outcomes, including hypertensive disorders, preterm delivery, macrosomia/large for gestational age (LGA), pregnancy loss, adverse maternal outcomes, adverse neonatal outcomes, and adverse fetal outcomes. DATA EXTRACTION In this meta-analysis, both fixed and random effect models were used. Publication bias was also evaluated by Egger test and the funnel plot, and the trim and fill method was conducted in case of a significant result, to adjust the bias. RESULTS Of 202 records retrieved through searching databases, 11 studies were selected for the final analyses. There were no significant differences in pooled ORs of hypertensive disorders, preterm delivery, macrosomia/LGA, and pregnancy loss in pregnant women with subclinical hyperthyroidism, compared to the euthyroid controls. The pooled OR of adverse maternal, neonatal, and fetal outcomes in pregnant women with subclinical hyperthyroidism was not statistically significantly different from that of the euthyroid control group. CONCLUSIONS The current meta-analysis demonstrated that subclinical hyperthyroidism in pregnancy is not related with adverse maternal and fetal outcomes. Therefore, clinicians should be avoided unnecessary treatments for pregnant women with subclinical hyperthyroidism.
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Affiliation(s)
- Sima Nazarpour
- Department of Midwifery, Varamin-Pishva Branch, Islamic Azad University, Tehran, Iran
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Razieh Bidhendi Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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11
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Obeid M, Kazi M. Plasmapheresis as a treatment of thyrotoxicosis in pregnancy: Case report. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.jecr.2022.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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12
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Dhillon-Smith RK, Boelaert K. Preconception Counseling and Care for Pregnant Women with Thyroid Disease. Endocrinol Metab Clin North Am 2022; 51:417-436. [PMID: 35662450 DOI: 10.1016/j.ecl.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Thyroid disease is associated with adverse maternal and fetal outcomes. Appropriate reference ranges should be used for the interpretation of test results, although universal screening for thyroid dysfunction is not warranted. Overt thyroid dysfunction requires careful consideration of medication adjustments and close monitoring. Mild thyroid hypofunction has been linked to adverse pregnancy outcomes including preterm delivery, and poor neurocognition in the offspring. This review summarizes the most recent evidence on the counseling and management of women with thyroid disease before and during pregnancy and highlights the areas of controversy in need of further research.
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Affiliation(s)
- Rima K Dhillon-Smith
- Institute of Metabolism and Systems Research, Tommy's National Centre for Miscarriage Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Kristien Boelaert
- Institute of Applied Health Research, Room 232 Murray Learning Centre, University of Birmingham, Birmingham, B15 2FG, UK.
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He X, Yan Q, Liu C, Wang Z, Liao P, Liu T, Shi Z, Song Q, Cui X, Wang W, Zang J. Association of maternal thyroid dysfunction and autoimmunity with adverse birth outcomes. Endocr Connect 2022; 11:e210599. [PMID: 35294399 PMCID: PMC9066600 DOI: 10.1530/ec-21-0599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/16/2022] [Indexed: 11/15/2022]
Abstract
This study aimed to explore the relationship between thyroid function and autoimmunity and adverse birth outcomes. Serum levels of thyroid function were detected by electrochemiluminescence assay. Urine iodine concentration was detected using the acid digestion method. We used multiple linear regression to assess the correlation between thyroid function indicators and birth weight according to trimester stratification and binary logistic regression to evaluate the correlation between thyroid dysfunction and adverse birth outcomes. Reference ranges for trimester-specific thyroid hormones were established in our 2564 pregnant women cohort with mild iodine deficiency. The higher the maternal thyroid-stimulating hormone in the first trimester (B = 0.09, P = 0.048) and total triiodothyronine (TT3) in the third trimester (B = 0.16, P < 0.001) of TPOAbnegative women, the higher the birth weight Z-score, whereas in the second trimester, free-thyroxine of mothers with TPOAb negative was lower (B = -0.10, P = 0.026) and the birth weight Z-score was higher. Pregnant women with overt and subclinical hyperthyroidism had a higher risk of preterm births than euthyroid women (11.9% vs 4.5%; odds ratio (OR): 2.84; P = 0.009). Women with higher TT3 had a higher risk of preterm (17.0% vs 4.5%; OR: 4.19; P < 0.001) and LGA (34.0% vs 11.1%; OR: 3.70; P < 0.001) births than euthyroid women. In conclusion, thyroid function during pregnancy could affect birth weight and birth outcome.
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Affiliation(s)
- Xin He
- Laboratory of Functional Medicine, Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Qin Yan
- Laboratory of Functional Medicine, Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Chazhen Liu
- Laboratory of Functional Medicine, Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Zhengyuan Wang
- Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Ping Liao
- Laboratory of Functional Medicine, Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Tong Liu
- Laboratory of Functional Medicine, Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Zehuan Shi
- Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Qi Song
- Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Xueying Cui
- Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Wenjing Wang
- Laboratory of Functional Medicine, Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jiajie Zang
- Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
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14
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Toloza FJK, Derakhshan A, Männistö T, Bliddal S, Popova PV, Carty DM, Chen L, Taylor P, Mosso L, Oken E, Suvanto E, Itoh S, Kishi R, Bassols J, Auvinen J, López-Bermejo A, Brown SJ, Boucai L, Hisada A, Yoshinaga J, Shilova E, Grineva EN, Vrijkotte TGM, Sunyer J, Jiménez-Zabala A, Riaño-Galan I, Lopez-Espinosa MJ, Prokop LJ, Singh Ospina N, Brito JP, Rodriguez-Gutierrez R, Alexander EK, Chaker L, Pearce EN, Peeters RP, Feldt-Rasmussen U, Guxens M, Chatzi L, Delles C, Roeters van Lennep JE, Pop VJM, Lu X, Walsh JP, Nelson SM, Korevaar TIM, Maraka S. Association between maternal thyroid function and risk of gestational hypertension and pre-eclampsia: a systematic review and individual-participant data meta-analysis. Lancet Diabetes Endocrinol 2022; 10:243-252. [PMID: 35255260 PMCID: PMC10314731 DOI: 10.1016/s2213-8587(22)00007-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/24/2021] [Accepted: 01/04/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Adequate maternal thyroid function is important for an uncomplicated pregnancy. Although multiple observational studies have evaluated the association between thyroid dysfunction and hypertensive disorders of pregnancy, the methods and definitions of abnormalities in thyroid function tests were heterogeneous, and the results were conflicting. We aimed to examine the association between abnormalities in thyroid function tests and risk of gestational hypertension and pre-eclampsia. METHODS In this systematic review and meta-analysis of individual-participant data, we searched MEDLINE (Ovid), Embase, Scopus, and the Cochrane Database of Systematic Reviews from date of inception to Dec 27, 2019, for prospective cohort studies with data on maternal concentrations of thyroid-stimulating hormone (TSH), free thyroxine (FT4), thyroid peroxidase (TPO) antibodies, individually or in combination, as well as on gestational hypertension, pre-eclampsia, or both. We issued open invitations to study authors to participate in the Consortium on Thyroid and Pregnancy and to share the individual-participant data. We excluded participants who had pre-existing thyroid disease or multifetal pregnancy, or were taking medications that affect thyroid function. The primary outcomes were documented gestational hypertension and pre-eclampsia. Individual-participant data were analysed using logistic mixed-effects regression models adjusting for maternal age, BMI, smoking, parity, ethnicity, and gestational age at blood sampling. The study protocol was registered with PROSPERO, CRD42019128585. FINDINGS We identified 1539 published studies, of which 33 cohorts met the inclusion criteria and 19 cohorts were included after the authors agreed to participate. Our study population comprised 46 528 pregnant women, of whom 39 826 (85·6%) women had sufficient data (TSH and FT4 concentrations and TPO antibody status) to be classified according to their thyroid function status. Of these women, 1275 (3·2%) had subclinical hypothyroidism, 933 (2·3%) had isolated hypothyroxinaemia, 619 (1·6%) had subclinical hyperthyroidism, and 337 (0·8%) had overt hyperthyroidism. Compared with euthyroidism, subclinical hypothyroidism was associated with a higher risk of pre-eclampsia (2·1% vs 3·6%; OR 1·53 [95% CI 1·09-2·15]). Subclinical hyperthyroidism, isolated hypothyroxinaemia, or TPO antibody positivity were not associated with gestational hypertension or pre-eclampsia. In continuous analyses, both a higher and a lower TSH concentration were associated with a higher risk of pre-eclampsia (p=0·0001). FT4 concentrations were not associated with the outcomes measured. INTERPRETATION Compared with euthyroidism, subclinical hypothyroidism during pregnancy was associated with a higher risk of pre-eclampsia. There was a U-shaped association of TSH with pre-eclampsia. These results quantify the risks of gestational hypertension or pre-eclampsia in women with thyroid function test abnormalities, adding to the total body of evidence on the risk of adverse maternal and fetal outcomes of thyroid dysfunction during pregnancy. These findings have potential implications for defining the optimal treatment target in women treated with levothyroxine during pregnancy, which needs to be assessed in future interventional studies. FUNDING Arkansas Biosciences Institute and Netherlands Organization for Scientific Research.
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Affiliation(s)
- Freddy J K Toloza
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Department of Medicine, MetroWest Medical Center, Tufts Medical School, Framingham, MA, USA
| | - Arash Derakhshan
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Tuija Männistö
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland; Northern Finland Laboratory Center Nordlab, University of Oulu, Oulu, Finland
| | - Sofie Bliddal
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Polina V Popova
- Department of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia; Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia; World-Class Research Center for Personalized Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russia; Department of Internal Diseases and Endocrinology, St Petersburg Pavlov State Medical University, Saint Petersburg, Russia
| | - David M Carty
- Department of Diabetes, Endocrinology and Clinical Pharmacology, Glasgow Royal Infirmary, Glasgow, UK; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Liangmiao Chen
- Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peter Taylor
- Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Lorena Mosso
- Department of Endocrinology and Centro Traslacional en Endocrinologia, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Eila Suvanto
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Sachiko Itoh
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute, Dr Josep Trueta Hospital, Girona, Spain
| | - Juha Auvinen
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute, Dr Josep Trueta Hospital, Girona, Spain
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Laura Boucai
- Division of Endocrinology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell University, New York, NY, USA
| | - Aya Hisada
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Jun Yoshinaga
- Faculty of Life Sciences, Toyo University, Gunma, Japan
| | - Ekaterina Shilova
- Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia; Department of Gynecology and Endocrinology, DO Ott Research Institute of Obstetrics and Gynecology, Saint Petersburg, Russia
| | - Elena N Grineva
- Department of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia; Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Tanja G M Vrijkotte
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Ana Jiménez-Zabala
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain; BIODONOSTIA Health Research Institute, San Sebastian, Spain; Public Health Division of Gipuzkoa, Basque Government, San Sebastian, Spain
| | - Isolina Riaño-Galan
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain; AGC Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain; IUOPA-Departamento de Medicina-ISPA, Universidad de Oviedo, Oviedo, Spain
| | - Maria-Jose Lopez-Espinosa
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain; Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain; Faculty of Nursing and Chiropody, Universitat de València, Valencia, Spain
| | | | - Naykky Singh Ospina
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rene Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Department of Internal Medicine, University Hospital Dr Jose E Gonzalez, Autonomous University of Nuevo León, Monterrey, Mexico; Plataforma INVEST Medicina UANL-KER Unit, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Erik K Alexander
- Division of Endocrinology, Hypertension and Diabetes, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Layal Chaker
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA, USA
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mònica Guxens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, Netherlands; ISGlobal, Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Leda Chatzi
- Department of Population and Public Health Sciences, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Xuemian Lu
- Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Medical School, University of Western Australia, Crawley, WA, Australia
| | | | - Tim I M Korevaar
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.
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15
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Cheng PK, Chen HC, Kuo PL, Chang JW, Chang WT, Huang PC. Associations between Oxidative/Nitrosative Stress and Thyroid Hormones in Pregnant Women—Tainan Birth Cohort Study (TBCS). Antioxidants (Basel) 2022; 11:antiox11020334. [PMID: 35204216 PMCID: PMC8868566 DOI: 10.3390/antiox11020334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/24/2022] [Accepted: 02/08/2022] [Indexed: 12/15/2022] Open
Abstract
Oxidative and nitrosative stress have been linked to thyroid function in both animal and human studies. In the present study, the associations between oxidative and nitrosative stress and thyroid hormones were investigated. Measurements were obtained from 97 Taiwanese pregnant women at the first, second, and third trimesters. Levels of five oxidative and nitrosative stress biomarkers (8-hydroxy-2′-deoxyguanosine [8-OHdG], 8-nitroguanine [8-NO2Gua], 4-hydroxy-2-nonenal-mercapturic acid [HNE-MA], 8-isoprostaglandin F2α [8-isoPGF2α], and malondialdehyde [MDA]) were measured using urine samples, and levels of five thyroid hormones (triiodothyronine [T3], thyroxine [T4], free T4, thyroid-stimulating hormone [TSH], and T4-binding globulin [TBG]) were measured in blood samples. Multiple linear regressions and linear mixed-model regressions were conducted to determine the associations between oxidative or nitrosative stress biomarkers and thyroid hormones in pregnant women. We found that TSH was negatively and significantly associated with 8-NO2Gua (−14%, 95% CI [−26.9% to −1.1%]) and HNE-MA (−23%, 95% CI [−35.9% to −10.0%]) levels. However, T4 (3%, 95% CI [0.2%–5.8%]) and free T4 (4.3%, 95% CI [0.8%–7.8%]) levels were positively and significantly associated with 8-NO2Gua. The T4 to TBG and free T4 to TBG ratios were positively and significantly associated with 8-NO2Gua level (T4/TBG: 3.6%, 95% CI [0.5%–6.7%]; free T4/TBG: 5.6%, 95% CI [0.2%–11.1%]). However, the TSH to T4 ratio was negatively and significantly associated with 8-NO2Gua level (−17.3%, 95% CI [−30.4% to −4.3%]). The T3 to TSH ratio was positively and significantly associated with HNE-MA level (25.2%, 95% CI [11.2%–39.2%]). However, the TSH to T4 and TSH to free T4 ratios were negatively and significantly associated with HNE-MA level (TSH/T4: −21.2%, 95% CI [−34.5% to −7.8%] and TSH/free T4: −24.0%, 95% CI [−38.3% to −9.6%]). Our findings suggest that an imbalance of oxidative and nitrosative stress may alter thyroid hormone homeostasis during pregnancy. Disruption of the maternal thyroid homeostasis during pregnancy would affect embryonic and fetal development.
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Affiliation(s)
- Po-Keng Cheng
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 35053, Taiwan; (P.-K.C.); (W.-T.C.)
| | - Hsin-Chang Chen
- Department of Chemistry, Tunghai University, Taichung 40704, Taiwan;
| | - Pao-Lin Kuo
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, Tainan 70101, Taiwan;
| | - Jung-Wei Chang
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
| | - Wan-Ting Chang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 35053, Taiwan; (P.-K.C.); (W.-T.C.)
| | - Po-Chin Huang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 35053, Taiwan; (P.-K.C.); (W.-T.C.)
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- Correspondence: ; Tel.: +886-37-206-166 (ext. 38507)
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16
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Zhou Y, Liu Y, Zhang Y, Zhang Y, Wu W, Fan J. Identifying Non-Linear Association Between Maternal Free Thyroxine and Risk of Preterm Delivery by a Machine Learning Model. Front Endocrinol (Lausanne) 2022; 13:817595. [PMID: 35282469 PMCID: PMC8907667 DOI: 10.3389/fendo.2022.817595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/17/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Preterm delivery (PTD) is the primary cause of mortality in infants. Mounting evidence indicates that thyroid dysfunction might be associated with an increased risk of PTD, but the dose-dependent association between the continuous spectrum maternal free thyroxine (FT4) and PTD is still not well-defined. This study aimed to further investigate this relationship using a machine learning-based model. METHODS A hospital-based cohort study was conducted from January 2014 to December 2018 in Shanghai, China. Pregnant women who delivered singleton live births and had first-trimester thyroid function data available were included. The generalized additive models with penalized cubic regression spline were applied to explore the non-linear association between maternal FT4 and risk of PTD and also subtypes of PTD. The time-to-event method and multivariable Cox proportional hazard model were further applied to analyze the association of abnormally high and low maternal FT4 concentrations with the timing of PTD. RESULTS A total of 65,565 singleton pregnancies with completed medical records and no known thyroid disease before pregnancy were included for final analyses. There was a U-shaped dose-dependent relationship between maternal FT4 in the first trimester and PTD (p <0.001). Compared with the normal range of maternal FT4, increased risk of PTD was identified in both low maternal FT4 (<11.7 pmol/L; adjusted hazard ratio [HR] 1.34, 95% CI [1.13-1.59]) and high maternal FT4 (>19.7 pmol/L; HR 1.41, 95% CI [1.13-1.76]). The association between isolated hypothyroxinemia and PTD was mainly associated with spontaneous PTD (HR 1.33, 95% CI [1.11-1.59]) while overt hyperthyroidism may be attributable to iatrogenic PTD (HR 1.51, 95% CI [1.18-1.92]) when compared with euthyroid women. Additionally, mediation analysis identified that an estimated 11.80% of the association between overt hyperthyroidism and iatrogenic PTD risk was mediated via the occurrence of hypertensive disorders in pregnancy (p <0.001). CONCLUSIONS We revealed a U-shaped association between maternal FT4 and PTD for the first time, exceeding the clinical definition of maternal thyroid function test abnormalities. Our findings provide insights towards the need to establish optimal range of maternal FT4 concentrations for preventing adverse outcomes in pregnancy.
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Affiliation(s)
- Yulai Zhou
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yindi Liu
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yuan Zhang
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yong Zhang
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Weibin Wu
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- *Correspondence: Weibin Wu, ; Jianxia Fan,
| | - Jianxia Fan
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
- *Correspondence: Weibin Wu, ; Jianxia Fan,
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17
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Oprea D, Sauvé N, Pasquier JC. The impact of levothyroxine exposure on delivery outcome in hypothyroid pregnant women (PETAL study): A five-year retrospective cohort study. Obstet Med 2021; 15:260-266. [DOI: 10.1177/1753495x211064108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/15/2021] [Indexed: 11/15/2022] Open
Abstract
Background Hypothyroidism affects 3% of pregnant women, and to date, no studies have addressed the impact levothyroxine-treated hypothyroidism on delivery outcome. Methods This retrospective cohort study was conducted among 750 women with a singleton pregnancy who gave birth between 2015 and 2019. Delivery modes were compared between 250 hypothyroid women exposed to levothyroxine and 500 euthyroid control women. The aim of this study was to determine the impact of levothyroxine exposure on delivery outcome. Results Multiple logistic regression showed no significant association between exposure to levothyroxine and the overall rate of caesarean delivery (aOR 1.1; 95% CI 0.8 to 1.6). Mean TSH concentrations were significantly higher throughout the pregnancy in hypothyroid women despite levothyroxine treatment. Maternal and neonatal outcomes in both groups were not different. Conclusion Hypothyroidism treated with levothyroxine during pregnancy according to local guidelines is not a significant risk factor for caesarean delivery.
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Affiliation(s)
- Diana Oprea
- Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Canada
| | - Nadine Sauvé
- Division of Internal Medicine, Department of medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Canada
| | - Jean-Charles Pasquier
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Canada
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18
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Sun X, Liu C, Liang H, Miao M, Wang Z, Ji H, van Donkelaar A, Martin RV, Kan H, Yuan W. Prenatal exposure to residential PM 2.5 and its chemical constituents and weight in preschool children: A longitudinal study from Shanghai, China. ENVIRONMENT INTERNATIONAL 2021; 154:106580. [PMID: 33905944 DOI: 10.1016/j.envint.2021.106580] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/24/2021] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Studies have reported that prenatal exposure to fine particulate matter (PM2.5) might be associated with adverse birth outcomes in offspring. However, evidence with regard to the effects of prenatal exposure to PM2.5 and, especially, its main chemical constituents on offspring's weight in childhood is limited and inconsistent. OBJECTIVES The present study aimed to examine associations of prenatal exposure to PM2.5 total mass and its chemical constituents in each trimester with children's weight from birth to 6 years of age using data from Shanghai-Minhang Birth Cohort Study. METHODS A total of 1,084 mother-infant pairs were included with both PM2.5 exposure data and at least one measurement of weight and height. Weight-for-Length (WLZ), BMI-for-Age (BMIz), and Weight-for-Age (WAZ) z-scores were generated according to the World Health Organization guidelines. Exposure to PM2.5 total mass and its chemical constituents [organic carbon (OC), black carbon (BC), ammonium (NH4+), nitrate (NO3-), sulfate (SO42-), and soil dust (SOIL)] during pregnancy was estimated from a satellite based modelling framework. We used multiple informant model to estimate the associations of trimester-specific PM2.5 total mass and its specific constituents concentrations with WLZ/BMIz and WAZ of offspring at birth and 1, 4, and 6 years of age. RESULTS In multiple informant model, we observed consistent patterns of associations between exposure to PM2.5 total mass, OC, BC, NH4+, NO3-, and SO42- during the 2nd and 3rd trimesters and decreased WLZ/BMIz and WAZ at 1, 4, and 6 years of age in boys. We observed associations between prenatal exposure to PM2.5 total mass, NH4+, and NO3- during the 1st and 2nd trimesters and increased WLZ/BMIz and WAZ in girls at birth. However, there were null associations at 1 and 4 years of age and inverse associations at 6 years of age. CONCLUSIONS Prenatal exposure to PM2.5 total mass and its main chemical constituents was associated with decreased weight in boys from 1 to 6 years of age, with increased weight at birth and decreased weight at 6 years of age in girls. Our findings suggest that prenatal exposure to PM2.5 and its chemical constituents may have a lasting effect on offspring's weight in childhood.
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Affiliation(s)
- Xiaowei Sun
- NHC Key Lab. Of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, 779 Old Hu Min Road, Shanghai 200237, China
| | - Cong Liu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, 130 Dong An Road, Shanghai 200032, China
| | - Hong Liang
- NHC Key Lab. Of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, 779 Old Hu Min Road, Shanghai 200237, China
| | - Maohua Miao
- NHC Key Lab. Of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, 779 Old Hu Min Road, Shanghai 200237, China
| | - Ziliang Wang
- NHC Key Lab. Of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, 779 Old Hu Min Road, Shanghai 200237, China
| | - Honglei Ji
- NHC Key Lab. Of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, 779 Old Hu Min Road, Shanghai 200237, China
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, B3H 4R2 Halifax, Nova Scotia, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA; Atomic and Molecular Physics Division, Harvard-Smithsonian Center for Astrophysics, 60 Garden St, Cambridge, MA 02138, USA
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, B3H 4R2 Halifax, Nova Scotia, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA; Atomic and Molecular Physics Division, Harvard-Smithsonian Center for Astrophysics, 60 Garden St, Cambridge, MA 02138, USA
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, 130 Dong An Road, Shanghai 200032, China; Children's Hospital of Fudan University, National Center for Children's Health, Shanghai 201102, China.
| | - Wei Yuan
- NHC Key Lab. Of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, 779 Old Hu Min Road, Shanghai 200237, China
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Luo J, Wang X, Yuan L, Guo L. Association of thyroid disorders with gestational diabetes mellitus: a meta-analysis. Endocrine 2021; 73:550-560. [PMID: 33983493 DOI: 10.1007/s12020-021-02712-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/23/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE The current meta-analysis aimed to evaluate the association of thyroid dysfunction and autoimmunity with gestational diabetes mellitus (GDM). METHODS A comprehensive search from PubMed, Embase, MEDLINE, and Cochrane databases until November 2020 was conducted. Fixed-effect model was used to combine the results when I2 was <50%. Random-effect model was used to summarize the results when I2 was >50%. RESULTS A total of 44 studies were included in the meta-analysis. Low FT4 levels were closely related with GDM in the first and second trimesters of gestation. Hypothyroxinemia (OR: 1.45; 95% CI: 1.25, 1.68; P < 0.00001), overt (OR: 1.80; 95% CI: 1.73, 1.86; P < 0.00001), and subclinical (OR: 1.54; 95% CI: 1.03, 2.30; P = 0.03) hypothyroidism, overt hyperthyroidism (OR: 1.49; 95% CI: 1.09, 2.04; P = 0.01), and positive thyroid antibodies (OR: 1.49; 95% CI: 1.07, 2.07; P < 0.00001) were observed significantly associated with the risk of GDM. Pregnant women with subclinical hyperthyroidism were less likely to develop GDM (OR: 0.62; 95% CI: 0.39, 0.97; P = 0.04). CONCLUSIONS Thyroid dysfunction and positive thyroid antibodies were associated with the risk of GDM. Our findings suggest that pregnant women with these thyroid diseases may be offered screening for GDM comprehensively.
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Affiliation(s)
- Jingyi Luo
- Department of Endocrinology, The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Xiaoxia Wang
- Department of Endocrinology, The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Li Yuan
- The Savaid School of Medicine, University of Chinese Academy of Sciences, Beijing, PR China
| | - Lixin Guo
- Department of Endocrinology, The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
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Singhal S, Meena J, Kumar S, Roy KK, Singh N, Shekhar B, Yadav A, Kumari S, Jayraj AS. Maternal and Perinatal Outcomes of Pregnancy in Women With Autoimmune Disorder. Cureus 2021; 13:e16024. [PMID: 34336512 PMCID: PMC8320712 DOI: 10.7759/cureus.16024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/14/2022] Open
Abstract
Objective Pregnancy with an autoimmune disorder is faced with several risks for mother and fetus. The aim of the present study is to analyze the course and outcome of pregnancy in women with autoimmune disorders (AIDs). Methods A retrospective cohort study was conducted at a tertiary care teaching hospital. The hospital records of 153 pregnancies with autoimmune disorders and 1095 low-risk pregnant women who served as controls were reviewed. An adverse perinatal outcome was defined as the presence of any obstetric complications, including preeclampsia, eclampsia, abruption, antepartum hemorrhage (APH), prematurity, fetal growth restriction (FGR), intrauterine death (IUD), intrapartum event, mode of delivery, birth weight, neonatal intensive care unit (NICU) stay, or disease-specific neonatal complications. For all statistical tests with two-tailed probability, p<0.05 was considered statistically significant. Results A high incidence of adverse perinatal outcomes was observed in all women with AIDs when compared with age-matched controls. The highest incidence of adverse perinatal outcomes was observed in women with Takayasu’s arteritis. The incidence of abortions was more in women with antiphospholipid antibody syndrome (APS) and Grave’s disease (22.2% and 33.3%, respectively). The incidence of prematurity, fetal growth restriction (FGR), and low birth weight were highest in women with systemic lupus erythematosus (SLE). Pregnancy with myasthenia gravis and rheumatoid arthritis did not have any significant adverse impact on pregnancy outcomes. Conclusion We found a strong association between autoimmune disorders and obstetric complications. The multidisciplinary team approach and pre-pregnancy optimization of the disease improve maternal and fetal outcomes.
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Affiliation(s)
- Seema Singhal
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Jyoti Meena
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Sunesh Kumar
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - K K Roy
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Neeta Singh
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Bhawani Shekhar
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Anshu Yadav
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Sarita Kumari
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Aarthi S Jayraj
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
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21
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Birru RL, Liang HW, Farooq F, Bedi M, Feghali M, Haggerty CL, Mendez DD, Catov JM, Ng CA, Adibi JJ. A pathway level analysis of PFAS exposure and risk of gestational diabetes mellitus. Environ Health 2021; 20:63. [PMID: 34022907 PMCID: PMC8141246 DOI: 10.1186/s12940-021-00740-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/27/2021] [Indexed: 05/12/2023]
Abstract
Per- and polyfluoroalkyl substances (PFAS) have been found to be associated with gestational diabetes mellitus (GDM) development, a maternal health disorder in pregnancy with negative effects that can extend beyond pregnancy. Studies that report on this association are difficult to summarize due to weak associations and wide confidence intervals. One way to advance this field is to sharpen the biologic theory on a causal pathway behind this association, and to measure it directly by way of molecular biomarkers. The aim of this review is to summarize the literature that supports a novel pathway between PFAS exposure and GDM development. Epidemiological studies demonstrate a clear association of biomarkers of thyroid hormones and glucose metabolism with GDM development. We report biologic plausibility and epidemiologic evidence that PFAS dysregulation of maternal thyroid hormones and thyrotropin (TSH) may disrupt glucose homeostasis, increasing the risk of GDM. Overall, epidemiological studies demonstrate that PFAS were positively associated with TSH and negatively with triiodothyronine (T3) and thyroxine (T4). PFAS were generally positively associated with glucose and insulin levels in pregnancy. We propose dysregulation of thyroid function and glucose metabolism may be a critical and missing component in the accurate estimation of PFAS on the risk of GDM.
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Affiliation(s)
- Rahel L. Birru
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Hai-Wei Liang
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Fouzia Farooq
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Megha Bedi
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, PA USA
| | - Maisa Feghali
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Catherine L. Haggerty
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Dara D. Mendez
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Janet M. Catov
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Carla A. Ng
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, PA USA
- Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Jennifer J. Adibi
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
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Yang Y, Guo T, Fu J, Kuang J, Wang Y, Zhang Y, Zhang H, He Y, Peng Z, Wang Q, Shen H, Zhang Y, Yan D, Ma X, Guan H. Preconception Thyrotropin Levels and Risk of Adverse Pregnancy Outcomes in Chinese Women Aged 20 to 49 Years. JAMA Netw Open 2021; 4:e215723. [PMID: 33847747 PMCID: PMC8044736 DOI: 10.1001/jamanetworkopen.2021.5723] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Maternal thyrotropin levels during gestation have a profound effect on pregnancy outcomes; however, few studies to date have evaluated the importance of preconception thyrotropin levels. OBJECTIVE To investigate the associations between preconception thyrotropin levels and pregnancy outcomes. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study enrolled Chinese women aged 20 to 49 years from the National Free Prepregnancy Checkups Project in China. Participants conceived within 6 months after the thyrotropin examination and completed follow-up for pregnancy outcomes between January 1, 2013, and December 31, 2017. Data were analyzed between May 1, 2019, and March 31, 2020. EXPOSURES Levels of thyrotropin within 6 months before pregnancy, measured as less than 0.10 mIU/L, 0.10 to 0.36 mIU/L, 0.37 to 2.49 mIU/L, 2.50 to 4.87 mIU/L, 4.88 to 9.99 mIU/L, and 10.00 mIU/L or greater. MAIN OUTCOMES AND MEASURES The association of maternal preconception thyrotropin levels with the 4 primary adverse pregnancy outcomes was assessed, including preterm birth (PTB), small for gestational age (SGA), birth defect, and perinatal infant death. Logistic regression analyses were used to evaluate the association between preconception maternal thyrotropin levels and risk of adverse pregnancy outcomes. The dose-response associations were assessed using restricted cubic spline regression. RESULTS This study enrolled 5 840 894 women (mean [SD] age, 26.30 [4.10] years) in the primary analysis. The median (interquartile range [IQR]) thyrotropin level was 1.60 (1.06-2.37) mIU/L. The cumulative incidences for the adverse pregnancy outcomes were as follows: PTB, 6.56%; SGA, 7.21%; birth defect, 0.02%; and perinatal infant death, 0.33%. Compared with the reference group (thyrotropin range, 0.37-2.49 mIU/L), both low (<0.10 mIU/L and 0.10-0.36 mIU/L) and high (4.88-9.99 mIU/L and ≥10.00 mIU/L) maternal preconception thyrotropin levels were associated with higher risk of PTB (low: odds ratio [OR], 1.23 [95% CI, 1.19-1.27] and OR, 1.15 [95% CI, 1.13-1.18] vs high: OR, 1.13 [95% CI, 1.10-1.15] and OR, 1.14 [95% CI, 1.08-1.20]), SGA (low: OR, 1.37 [95% CI, 1.33-1.40] and OR, 1.14 [95% CI, 1.12-1.17] vs high: OR, 1.05 [95% CI, 1.03-1.08] and OR, 1.17 [95% CI, 1.11-1.23]), and perinatal infant death (low: OR, 1.26 [95% CI, 1.10-1.43] and OR, 1.14 [95% CI, 1.05-1.24] vs high: OR, 1.31 [95% CI, 1.20-1.43] and OR, 1.47 [95% CI, 1.21-1.80]). J-shaped associations between preconception thyrotropin levels and PTB (χ2 = 1033.45; nonlinear P < .001), SGA (χ2 = 568.90; nonlinear P < .001), and perinatal infant death (χ2 = 38.91; nonlinear P < .001) were identified. CONCLUSIONS AND RELEVANCE In this cohort study, both low and high maternal thyrotropin levels were associated with a significantly increased risk of adverse pregnancy outcomes. Results suggest that the optimal preconception thyrotropin levels may be between 0.37 mIU/L and 2.50 mIU/L to prevent adverse pregnancy outcomes.
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Affiliation(s)
- Ying Yang
- National Research Institute for Family Planning, Haidian District, Beijing, China
- National Human Genetic Resource Center, Haidian District, Beijing, China
- Graduate School of Peking Union Medical College, Dongdan Santiao, Dongcheng District, Beijing, China
| | - Tonglei Guo
- National Research Institute for Family Planning, Haidian District, Beijing, China
- School of Public Health, Hebei Medical University, Changan District, Shijiazhuang, China
| | - Jinrong Fu
- Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang, China
| | - Jian Kuang
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, Haidian District, Beijing, China
- National Human Genetic Resource Center, Haidian District, Beijing, China
| | - Ya Zhang
- National Research Institute for Family Planning, Haidian District, Beijing, China
- National Human Genetic Resource Center, Haidian District, Beijing, China
| | - Hongguang Zhang
- National Research Institute for Family Planning, Haidian District, Beijing, China
- National Human Genetic Resource Center, Haidian District, Beijing, China
| | - Yuan He
- National Research Institute for Family Planning, Haidian District, Beijing, China
- National Human Genetic Resource Center, Haidian District, Beijing, China
| | - Zuoqi Peng
- National Research Institute for Family Planning, Haidian District, Beijing, China
- National Human Genetic Resource Center, Haidian District, Beijing, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health Commission of the People’s Republic of China, Xicheng District, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health Commission of the People’s Republic of China, Xicheng District, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health Commission of the People’s Republic of China, Xicheng District, Beijing, China
| | - Donghai Yan
- Department of Maternal and Child Health, National Health Commission of the People’s Republic of China, Xicheng District, Beijing, China
| | - Xu Ma
- National Research Institute for Family Planning, Haidian District, Beijing, China
- National Human Genetic Resource Center, Haidian District, Beijing, China
- Graduate School of Peking Union Medical College, Dongdan Santiao, Dongcheng District, Beijing, China
| | - Haixia Guan
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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23
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Turunen S, Vääräsmäki M, Lahesmaa-Korpinen AM, Leinonen MK, Gissler M, Männistö T, Suvanto E. Maternal hyperthyroidism and pregnancy outcomes: A population-based cohort study. Clin Endocrinol (Oxf) 2020; 93:721-728. [PMID: 32657434 DOI: 10.1111/cen.14282] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/01/2020] [Accepted: 07/05/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Maternal hyperthyroidism and antithyroid medications have been associated with adverse pregnancy and perinatal outcomes. This nationwide register-based study investigated the association of maternal hyperthyroidism and antithyroid drug (ATD) use with pregnancy outcomes and included all singleton births in Finland between 2004 and 2013 (N = 571 785). DESIGN, PATIENTS AND MEASUREMENTS Hyperthyroid mothers were identified in the Medical Birth Register, and data on ATD use before and/or during pregnancy were collected from the Prescription Register. The odds ratios, with 95% confidence intervals, for adverse outcomes among hyperthyroid mothers and mothers without thyroid disease were compared using logistic regression. RESULTS In total, 2144 (0.37%) of all the women had diagnoses of hyperthyroidism, and 580 (27%) of these women had used ATDs before and/or during pregnancy. Compared to the mothers without thyroid disease, maternal hyperthyroidism was associated with older age, multiparity, smoking, previous miscarriages, and overweight or obesity. The mothers diagnosed with hyperthyroidism also had increased odds of gestational hypertensive disorders, caesarean sections, placental abruptions, preterm births, small-for-gestational-age newborns and neonatal intensive care unit treatment. The odds of pregnancy and/or perinatal complications were higher among those who had used ATDs (indicative of active disease), but those who had not received ATD treatment also had increased odds of such complications compared to the mothers without thyroid disease. CONCLUSIONS Women with active hyperthyroidism and those with histories of hyperthyroidism should be considered at risk of developing pregnancy and perinatal complications and should therefore be monitored during pregnancy.
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Affiliation(s)
- Suvi Turunen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Marja Vääräsmäki
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | | | - Maarit K Leinonen
- Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Tuija Männistö
- Northern Finland Laboratory Centre Nordlab, Oulu University Hospital, Oulu, Finland
| | - Eila Suvanto
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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Abstract
Both thyrotoxicosis and hypothyroidism are associated with adverse pregnancy outcomes. There also is concern about the effect of overt maternal thyroid disease on fetal development. In addition, medications that affect the maternal thyroid gland can cross the placenta and affect the fetal thyroid gland. This document reviews the thyroid-related pathophysiologic changes that occur during pregnancy and the effects of overt and subclinical maternal thyroid disease on maternal and fetal outcomes. This Practice Bulletin has been updated with information on the diagnosis and the management of thyroid disease in pregnant women and includes a new clinical algorithm on management of thyroid disease in pregnancy.
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25
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The Clinical Value and Variation of Antithyroid Antibodies during Pregnancy. DISEASE MARKERS 2020; 2020:8871951. [PMID: 33144894 PMCID: PMC7599418 DOI: 10.1155/2020/8871951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 01/03/2023]
Abstract
Antithyroid antibodies, which include thyroid-stimulating hormone receptor antibodies (TRAbs), thyroid peroxidase antibodies (TPOAbs), and thyroid globulin antibodies (TgAbs), are widely known for their tight association with thyroid autoimmune diseases. The variation in all three kinds of antibodies also showed different trends during and after pregnancy (Weetman, 2010). This article reviewed the the physiological changes, while focusing on the variation of thyroid antibodies concentration in women during and after pregnancy, and adverse consequences related to their elevation. Since abnormal elevations of these antithyroid antibodies may lead to adverse outcomes in both mothers and fetuses, special attention must be paid to the titer of the antibodies during pregnancy. The molecular mechanisms of the variations in those antibodies have yet to be explained. The frequency and timing of thyroid antibody measurement, as well as different reference levels, also remain to be elucidated.
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Stagnaro-Green A, Dong A, Stephenson MD. Universal screening for thyroid disease during pregnancy should be performed. Best Pract Res Clin Endocrinol Metab 2020; 34:101320. [PMID: 31530447 DOI: 10.1016/j.beem.2019.101320] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Thyroid disease can significantly impact the pregnant woman and her child. Human and animal studies have firmly linked overt hypothyroidism and overt hyperthyroidism to miscarriage, preterm delivery and other adverse pregnancy outcomes. Overt hypothyroidism and overt hyperthyroidism affect 1% of all pregnancies. Treatment is widely available, and if detected early, results in decreased rates of adverse outcomes. Universal screening for thyroid disease in pregnancy can identify patients with thyroid disease requiring treatment, and ultimately decrease rates of complications. Universal screening is cost-effective compared to the currently accepted practice of targeted screening and may even be cost-saving in some healthcare systems. Targeted screening, which is recommended by most professional associations, fails to detect a large proportion of pregnant women with thyroid disease. In fact, an increasing number of providers are performing universal screening for thyroid disease in pregnancy, contrary to society guidelines. Limited evidence concerning the impact of untreated and treated subclinical disease and thyroid autoimmunity has distracted from the core rationale for universal screening - the beneficial impact of detecting and treating overt thyroid disease. Evidence supporting universal screening for overt disease stands independently from that of subclinical and autoimmune disease. The time to initiate universal screening is now.
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Affiliation(s)
- Alex Stagnaro-Green
- Department of Medicine, Obstetrics & Gynecology and Medical Education, University of Illinois College of Medicine at Rockford, 1601 Parkview Avenue, Rockford, IL 61107, USA.
| | - Allan Dong
- Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Chicago, 820 S. Wood Street, M/C 808, Chicago, IL 60612, USA.
| | - Mary D Stephenson
- Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Chicago, 820 S. Wood Street, M/C 808, Chicago, IL 60612, USA.
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27
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Derakhshan A, Peeters RP, Taylor PN, Bliddal S, Carty DM, Meems M, Vaidya B, Chen L, Knight BA, Ghafoor F, Popova PV, Mosso L, Oken E, Suvanto E, Hisada A, Yoshinaga J, Brown SJ, Bassols J, Auvinen J, Bramer WM, López-Bermejo A, Dayan CM, French R, Boucai L, Vafeiadi M, Grineva EN, Pop VJM, Vrijkotte TG, Chatzi L, Sunyer J, Jiménez-Zabala A, Riaño I, Rebagliato M, Lu X, Pirzada A, Männistö T, Delles C, Feldt-Rasmussen U, Alexander EK, Nelson SM, Chaker L, Pearce EN, Guxens M, Steegers EAP, Walsh JP, Korevaar TIM. Association of maternal thyroid function with birthweight: a systematic review and individual-participant data meta-analysis. Lancet Diabetes Endocrinol 2020; 8:501-510. [PMID: 32445737 PMCID: PMC8168324 DOI: 10.1016/s2213-8587(20)30061-9] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Adequate transplacental passage of maternal thyroid hormone is important for normal fetal growth and development. Maternal overt hypothyroidism and hyperthyroidism are associated with low birthweight, but important knowledge gaps remain regarding the effect of subclinical thyroid function test abnormalities on birthweight-both in general and during the late second and third trimester of pregnancy. The aim of this study was to examine associations of maternal thyroid function with birthweight. METHODS In this systematic review and individual-participant data meta-analysis, we searched MEDLINE (Ovid), Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and Google Scholar from inception to Oct 15, 2019, for prospective cohort studies with data on maternal thyroid function during pregnancy and birthweight, and we issued open invitations to identify study authors to join the Consortium on Thyroid and Pregnancy. We excluded participants with multiple pregnancies, in-vitro fertilisation, pre-existing thyroid disease or thyroid medication usage, miscarriages, and stillbirths. The main outcomes assessed were small for gestational age (SGA) neonates, large for gestational age neonates, and newborn birthweight. We analysed individual-participant data using mixed-effects regression models adjusting for maternal age, BMI, ethnicity, smoking, parity, gestational age at blood sampling, fetal sex, and gestational age at birth. The study protocol was pre-registered at the International Prospective Register of Systematic Reviews, CRD42016043496. FINDINGS We identified 2526 published reports, from which 36 cohorts met the inclusion criteria. The study authors for 15 of these cohorts agreed to participate, and five more unpublished datasets were added, giving a study population of 48 145 mother-child pairs after exclusions, of whom 1275 (3·1%) had subclinical hypothyroidism (increased thyroid stimulating hormone [TSH] with normal free thyroxine [FT4]) and 929 (2·2%) had isolated hypothyroxinaemia (decreased FT4 with normal TSH). Maternal subclinical hypothyroidism was associated with a higher risk of SGA than was euthyroidism (11·8% vs 10·0%; adjusted risk difference 2·43%, 95% CI 0·43 to 4·81; odds ratio [OR] 1·24, 1·04 to 1·48; p=0·015) and lower mean birthweight (mean difference -38 g, -61 to -15; p=0·0015), with a higher effect estimate for measurement in the third trimester than in the first or second. Isolated hypothyroxinaemia was associated with a lower risk of SGA than was euthyroidism (7·3% vs 10·0%, adjusted risk difference -2·91, -4·49 to -0·88; OR 0·70, 0·55 to 0·91; p=0·0073) and higher mean birthweight (mean difference 45 g, 18 to 73; p=0·0012). Each 1 SD increase in maternal TSH concentration was associated with a 6 g lower birthweight (-10 to -2; p=0·0030), with higher effect estimates in women who were thyroid peroxidase antibody positive than for women who were negative (pinteraction=0·10). Each 1 SD increase in FT4 concentration was associated with a 21 g lower birthweight (-25 to -17; p<0·0001), with a higher effect estimate for measurement in the third trimester than the first or second. INTERPRETATION Maternal subclinical hypothyroidism in pregnancy is associated with a higher risk of SGA and lower birthweight, whereas isolated hypothyroxinaemia is associated with lower risk of SGA and higher birthweight. There was an inverse, dose-response association of maternal TSH and FT4 (even within the normal range) with birthweight. These results advance our understanding of the complex relationships between maternal thyroid function and fetal outcomes, and they should prompt careful consideration of potential risks and benefits of levothyroxine therapy during pregnancy. FUNDING Netherlands Organization for Scientific Research (grant 401.16.020).
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Affiliation(s)
- Arash Derakhshan
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - Sofie Bliddal
- Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - David M Carty
- Department of Diabetes, Endocrinology and Clinical Pharmacology, Glasgow Royal Infirmary, Glasgow, UK; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Margreet Meems
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital National Health Service Foundation Trust, University of Exeter Medical School, Exeter, UK
| | - Liangmiao Chen
- Department of Endocrinology, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bridget A Knight
- National Institute for Health Research Exeter Clinical Research Facility, Royal Devon and Exeter Hospital National Health Service Foundation Trust, University of Exeter Medical School, Exeter, UK
| | - Farkhanda Ghafoor
- National Health Research Complex, Shaikh Zayed Medical Complex, Lahore, Pakistan
| | - Polina V Popova
- Almazov National Medical Research Centre, Saint Petersburg, Russia; Department of Faculty Therapy, St Petersburg Pavlov State Medical University, Saint Petersburg, Russia
| | - Lorena Mosso
- Department of Endocrinology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Boston, MA, USA; Harvard Pilgrim Health Care Institute, Boston, MA, USA; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Eila Suvanto
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Aya Hisada
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Jun Yoshinaga
- Faculty of Life Sciences, Toyo University, Gunma, Japan
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Dr Josep Trueta Hospital, Girona, Spain
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Wichor M Bramer
- Medical Library, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Dr Josep Trueta Hospital, Girona, Spain
| | - Colin M Dayan
- Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Robert French
- School of Medicine, Cardiff University, Cardiff, UK; Centre for Multilevel Modelling, University of Bristol, Bristol, UK
| | - Laura Boucai
- Department of Medicine, Division of Endocrinology, Memorial Sloan-Kettering Cancer Center, Weill Cornell University, New York, NY, USA
| | - Marina Vafeiadi
- Department of Social Medicine, University of Crete, Heraklion, Greece
| | - Elena N Grineva
- Almazov National Medical Research Centre, Saint Petersburg, Russia; Department of Faculty Therapy, St Petersburg Pavlov State Medical University, Saint Petersburg, Russia
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Tanja G Vrijkotte
- Department of Public Health, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, CA, USA
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Ana Jiménez-Zabala
- Biodonostia Health Research Institute, San Sebastian, Spain; Public Health Division of Gipuzkoa, Basque Government, San Sebastian, Spain
| | - Isolina Riaño
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Department of Pediatrics, Hospital Universitario Central de Asturias (Oviedo), Spain
| | - Marisa Rebagliato
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; School of Medicine, Universitat Jaume I, Castelló de la Plana, Spain
| | - Xuemian Lu
- Department of Endocrinology, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Tuija Männistö
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Northern Finland Laboratory Center Nordlab, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Erik K Alexander
- Division of Endocrinology, Hypertension and Diabetes, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow, UK; National Institute for Health Research, Bristol Biomedical Research Centre, Bristol, UK
| | - Layal Chaker
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands; Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA, USA
| | - Mònica Guxens
- ISGlobal, Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Department of Child and Adolescent Psychiatry/ Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Medical School, University of Western Australia, Crawley, WA, Australia
| | - Tim I M Korevaar
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands.
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Liu Y, Gao B, Zeng X, Yang J, Zhang L, Xu G, Jia R, Xu Z. Association between thyroid-stimulating hormone and maternal hemodynamics in hypertensive disorders of pregnancy: an observational study. BMC Pregnancy Childbirth 2019; 19:396. [PMID: 31675921 PMCID: PMC6824088 DOI: 10.1186/s12884-019-2556-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/14/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP) are characterized by hemodynamic disturbances. Altered thyroid function is a risk factor for poor outcomes of pregnancy. However, the associations between thyroid function biomarkers and maternal hemodynamics during pregnancy in HDP remain unclear. Methods From January 2016 to January 2018, pregnant women diagnosed with HDP admitted to the Nanjing Maternity and Child Health Care Hospital were prospectively enrolled in the third trimester. Normally distributed variables were expressed as mean ± standard deviation and skewed variables were expressed as median (25th percentile, 75th percentile). Correlations between thyroid-stimulating hormone (TSH) or free thyroxine (FT4) and maternal hemodynamic parameters were assessed by Pearson’s correlation coefficient and 95% confidence interval (95%CI). Bonferroni’s correction for multiple correlations was performed. Logistic regression models with odd ratio (OR) and 95%CI were applied to confirm the associations. Results A total of 163 third-trimester pregnant women with HDP with a mean gestational age of 35.62 ± 2.83 weeks were recruited. The infant birth weight of patients with elevated TSH levels was lower than that of patients with normal TSH levels (2635 ± 867 g vs. 3037 ± 673 g, p = 0.002). Reduced cardiac output (CO) was defined as CO < 3.5 L/min. The infant birth weight of patients with reduced CO was lower than that of patients with normal CO (2250 ± 510 g vs. 2890 ± 774 g, p = 0.002). TSH levels were significantly and negatively correlated with CO (r = − 0.260, 95%CI: − 0.392- -0.103, p < 0.001). FT4 levels were not significantly correlated with any of the maternal hemodynamic parameters (all p > 0.05). TSH level (OR = 1.371, 95%CI: 1.086–1.733, p = 0.008) was confirmed associated with reduced CO in the logistic regression analysis. Conclusions Elevated TSH levels are associated with reduced CO in HDP during the third trimester.
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Affiliation(s)
- Yu Liu
- Department of Obstetrics and Gynecology, The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University; Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, 210004, China
| | - Bo Gao
- Department of Clinical Nutrition, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, 321 Zhongshan Road, Gulou District, Nanjing, China
| | - Xin Zeng
- Department of Obstetrics and Gynecology, The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University; Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, 210004, China.,Nanjing Maternal and Child Health Institute, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, China
| | - Jing Yang
- Department of Science and Education, The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University; Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, China
| | - Lei Zhang
- Department of Obstetrics and Gynecology, The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University; Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, 210004, China
| | - Ganwei Xu
- Department of Medical Records, The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University; Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, China
| | - Ruizhe Jia
- Department of Obstetrics and Gynecology, The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University; Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, 210004, China.
| | - Zhengfeng Xu
- Department of Obstetrics and Gynecology, The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University; Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, 210004, China. .,Department of Prenatal Diagnosis, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Qinhuai District, Nanjing, China.
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Shan D, Bai Y, Chen QH, Wu YX, Chen Q, Hu YY. Hyperthyroid heart disease in pregnancy: Retrospective analysis of a case series and review of the literature. World J Clin Cases 2019; 7:2953-2962. [PMID: 31624743 PMCID: PMC6795740 DOI: 10.12998/wjcc.v7.i19.2953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hyperthyroidism in pregnancy may pose a great threat to maternal and fetal health. The risk of hyperthyroid heart disease (HHD), even heart failure, is significantly elevated in pregnant women.
AIM To investigate the clinical characteristics, prognosis, and therapy of HHD in pregnant women.
METHODS We searched the patient registry data at West China Second University Hospital of Sichuan University in Chengdu, China, following the approval by the Ethics Committee. We retrospectively analyzed the clinical characteristics of pregnant women diagnosed with HHD. The medical records of women with HHD during pregnancy from January 2012 to December 2017 were obtained from the electronic medical records system. All the included patients were followed in outpatient clinics and by telephone interviews until October 2018.
RESULTS A total of 155 patients were diagnosed with thyrotoxicosis, of whom six were diagnosed with HHD. Three of them had regular antenatal care. Two patients were complicated with acute heart failure attacks, and one of them had a stillbirth. Both of these patients had a long history of Graves’ disease with poor treatment compliance. Treatments of precipitating factors such as the control of infection could relieve the symptoms and prolong gestation for a better prognosis. Hyperthyroid heart failure could be controlled with aggressive diuretics and management of the coexisting complications. Intense monitoring and timely anti-heart failure treatment were crucial in patients with severe cardiac damage. Our findings indicated the importance of regular antenatal care and treatment adherence in patients with hyperthyroidism.
CONCLUSION The timely and accurate diagnosis of HHD and the implementation of effective management are important for a better prognosis in pregnant women with HHD. Improvement in patients’ awareness of thyrotoxicosis is needed.
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Affiliation(s)
- Dan Shan
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Yi Bai
- Department of Medical Records Management, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qiu-He Chen
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Yu-Xia Wu
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Qian Chen
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Ya-Yi Hu
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, Sichuan Province, China
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Abstract
PURPOSE OF REVIEW Graves' hyperthyroidism is associated with significant obstetric, maternal, fetal, and neonatal complications. Early diagnosis and an understanding of the management of Graves' hyperthyroidism in pregnancy can help to prevent these complications. Antithyroid drugs (ATD) should be avoided in early pregnancy, given their association with congenital malformations. RECENT FINDINGS TSH-receptor antibodies (TRAb) are integral in the management of Graves' hyperthyroidism in pregnancy and in the preconception period. TRAb are indicative of the current activity of Graves' hyperthyroidism and the likelihood of relapse. Furthermore, TRAb predicts the risk of fetal and neonatal hyperthyroidism.The incidence of congenital malformations is roughly the same for propylthiouracil (PTU) and methimazole (MMZ). Exposure to both ATDs in early pregnancy has been associated with increased incidence of congenital malformations compared with exposure to either ATD alone. SUMMARY The goal of the physician is maintaining euthyroidism throughout pregnancy and delivery of a healthy, euthyroid baby. An understanding of the natural progression of Graves' hyperthyroidism in pregnancy and the proper utilization of TRAb enables the physician to minimize the risks associated with Graves' hyperthyroidism and side effects of ATDs unique to pregnancy. The physician should prioritize preconception counseling in women with Graves' hyperthyroidism in order to avoid hyperthyroidism and having to use ATDs in pregnancy.
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Affiliation(s)
- Caroline T Nguyen
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine and Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Abstract
Clinical hyperthyroidism affects 0.1% to 0.4% of pregnancies. Gestational thyrotoxicosis is due to homology of the structure of TSH and HCG, which weakly stimulates the TSH receptor. Graves' disease (GD) most commonly causes clinically significant hyperthyroidism. Given concerns for teratogenicity from antithyroid drugs, these may be discontinued in low-risk GD patients. High-risk patients are treated with propylthiouracil in the first trimester then may transition to methimazole. Surgery is reserved for special circumstances; radioactive iodine is contraindicated. In late pregnancy, GD may remit; postpartum relapse is common. Measurement of serum thyrotropin receptor antibodies identifies pregnancies at-risk for fetal and neonatal hyperthyroidism.
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Affiliation(s)
- Kristen Kobaly
- Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, 4th Floor West Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Susan J Mandel
- Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, 4th Floor West Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Cai C, Chen W, Vinturache A, Hu P, Lu M, Gu H, Qiao J, Liu F, Tian Y, Gao Y, Ding G. Thyroid hormone concentrations in second trimester of gestation and birth outcomes in Shanghai, China. J Matern Fetal Neonatal Med 2019; 34:1897-1905. [PMID: 31397208 DOI: 10.1080/14767058.2019.1651273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Previous studies suggested that thyroid function in the first trimester of gestation played an important role in fetal growth. However, limited clinical data are available to support this relationship in the second trimester of gestation. OBJECTIVE We examined the relationship of maternal thyroid function parameters in early second trimester of gestation with birth outcomes in China. METHODS Participating 5016 mother-infant pairs were recruited from the Songjiang District Maternity and Infant Hospital, Shanghai, China, between July and December 2016. Linear regression assessed the associations of thyroid hormones with birthweight. Logistic regression tested the correlations between thyroid hormones and low birthweight, macrosomia, small for gestational age , and large for gestational age infants. Maternal serum TSH, TT3, TT4, FT3, and FT4 concentrations were measured in 16-20 weeks of gestation. RESULTS TT3 and FT3 were positively associated with birthweight, while TT4 and FT4 were negatively associated with birthweight, respectively. Furthermore, higher TT3 and FT3 were associated with increased risks of LGA infants (OR = 1.48, 95% CI: 1.15-1.9; OR = 1.22, 95% CI: 1.01-1.46), respectively. Higher TT3 was associated with an increased risk of macrosomic infants (OR = 1.35, 95% CI: 1.04-1.74). In contrast, higher FT4 was associated with decreased risks of LGA (OR = 0.87, 95% CI: 0.81-0.93) and macrosomic infants (OR = 0.90, 95% CI: 0.84-0.96), respectively. No associations were found between TSH and any of the outcomes. CONCLUSIONS TT3 and FT3 were positively associated with fetal growth, while TT4 and FT4 were negatively associated with fetal growth. Our findings suggested that thyroid function in early second trimester of gestation is a potential risk factor for abnormal fetal growth.
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Affiliation(s)
- Chen Cai
- Department of Pediatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Chen
- Shanghai Songjiang Maternal and Child Health Care Hospital, Shanghai, China
| | - Angela Vinturache
- Department Obstetrics & Gynecology, St. George's Hospital, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Peipei Hu
- Department of Pediatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Min Lu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Haoxiang Gu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Qiao
- Department of Pediatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fang Liu
- Department of Pediatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying Tian
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,MOE, Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Gao
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guodong Ding
- Department of Pediatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Wang X, Liu C, Zhang M, Han Y, Aase H, Villanger GD, Myhre O, Donkelaar AV, Martin RV, Baines EA, Chen R, Kan H, Xia Y. Evaluation of Maternal Exposure to PM 2.5 and Its Components on Maternal and Neonatal Thyroid Function and Birth Weight: A Cohort Study. Thyroid 2019; 29:1147-1157. [PMID: 31298631 DOI: 10.1089/thy.2018.0780] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Particulate matter (PM) air pollution is an environmental risk to public health. The prevalence of thyroid disease during pregnancy has increased rapidly in recent decades, but the available data on the relationships among air pollution, thyroid function, and birth outcomes in pregnant women, particularly in China, are scarce. We aimed to evaluate the association between maternal exposure to PM2.5 and its components and maternal and neonatal thyroid function and to investigate whether thyroid function acts as a mediator between air pollution and birth weight. Methods: In this prospective birth cohort study, the levels of maternal exposure to PM2.5 and its components during the first trimester were assessed in 433 pregnant women in Nanjing, China, enrolled during 2014-2015. We evaluated the levels of maternal exposure to PM2.5 and its six main constituents-organic matter (OM), black carbon (BC), sulfate (SO42-), nitrate (NO3-), ammonium (NH4+), and soil dust-using the V4.CH.02 product of the Dalhousie University Atmospheric Composition Analysis Group. The maternal serum-free thyroxine (fT4), thyrotropin (TSH), and thyroid peroxidase antibody (TPOAb) levels during the second trimester were measured through electrochemiluminescent microparticle immunoassays. The neonatal TSH levels were detected using an AutoDELFIA Neonatal TSH kit within 72 hours after birth, and the birth weight Z-score of each newborn was estimated. Results: Higher exposure to maternal PM2.5 and some components (BC and NH4+) decreased the maternal fT4 level (p < 0.05), and the birth weight Z-score was decreased (p < 0.05) by higher exposure to maternal PM2.5 and some components (OM, BC, NO3-, and NH4+). A mediation analysis clarified that the maternal fT4 levels explained 15.9%, 18.4%, and 20.9% of the associations of maternal PM2.5, BC, and NH4+ exposure with the birth weight Z-score, respectively (p < 0.05). After additional sensitivity analyses including only nonpreterm participants (n = 418) and non-TPOAb-positive participants (n = 415), the models remained stable. Conclusions: Our results suggest an inverse association between maternal exposure to PM2.5 and its components and the maternal fT4 levels. Maternal fT4 might act as a mediator between exposure to PM2.5 and its components and birth weight.
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Affiliation(s)
- Xu Wang
- 1State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- 2Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Cong Liu
- 3Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Mingzhi Zhang
- 1State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- 2Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yingying Han
- 1State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- 2Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Heidi Aase
- 4Department of Child Development and Norwegian Institute of Public Health, Oslo, Norway
| | - Gro Dehli Villanger
- 4Department of Child Development and Norwegian Institute of Public Health, Oslo, Norway
| | - Oddvar Myhre
- 5Department of Toxicology and Risk Assessment, Norwegian Institute of Public Health, Oslo, Norway
| | - Aaron van Donkelaar
- 6Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - Randall V Martin
- 6Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
- 7Harvard-Smithsonian Center for Astrophysics, Cambridge, Massachusetts
| | - Erica Anne Baines
- 8Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Renjie Chen
- 3Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Haidong Kan
- 3Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Yankai Xia
- 1State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- 2Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
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Cho GJ, Kim SY, Lee HC, Lee KM, Han SW, Oh MJ, Woodruff TK. Risk of Adverse Obstetric Outcomes and the Abnormal Growth of Offspring in Women with a History of Thyroid Cancer. Thyroid 2019; 29:879-885. [PMID: 30957663 PMCID: PMC8917897 DOI: 10.1089/thy.2018.0283] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background: It is unclear whether a history of thyroid cancer is associated with an increased risk of adverse pregnancy outcomes in subsequent pregnancies. This study aimed to evaluate the risk of adverse obstetric outcomes and the abnormal growth of offspring in women with a history of thyroid cancer. Methods: This retrospective observational study used nationwide data from between 2006 and 2014 to compare pregnancy outcomes of women with a history of thyroid cancer and those with no such history. Cases of thyroid cancer were identified using ICD-10 codes. Results: During the study period, 7232 women with a history of thyroid cancer and 2,269,051 women without a history of thyroid cancer gave birth. The risks of cesarean section, preterm birth, low birth weight, large for gestational age, preeclampsia, placental abruption, placenta previa, and stillbirth were not different between the groups. Women with a history of thyroid cancer had a statistically higher risk of postpartum hemorrhage (odds ratio [OR] = 1.23 [confidence interval (CI) 1.15-1.32], p < 0.05, corrected with the false discovery rate). Additionally, generalized estimating equations analysis showed that there was no difference in the risk of underweight (OR = 1.05 [CI 0.93-1.19]) and obese (OR = 0.94 [CI 0.84-1.05]) offspring assessed over a period of 80 months after adjusting for confounding factors. Conclusions: Women with a history of thyroid cancer have similar pregnancy outcomes and offspring growth to those with no such history.
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Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - So-youn Kim
- Olson Center for Women's Health, Department of Obstetrics and Gynecology, and Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
| | - Hoi Chang Lee
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kyu-Min Lee
- School of Industrial Management Engineering, Korea University, Seoul, Republic of Korea
| | - Sung Won Han
- School of Industrial Management Engineering, Korea University, Seoul, Republic of Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Teresa K. Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Address correspondence to: Teresa K. Woodruff, PhD, Feinberg School of Medicine Northwestern University, 303 E. Superior Street, Lurie 10-250119, Chicago, IL 60611
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Zhang Y, Li Y, Shan Z, Xu Y, Li C, Xie X, Li Y, Wang W, Mao J, Teng W. Association of Overt and Subclinical Hyperthyroidism During Weeks 4–8 with Adverse Pregnancy Outcomes. J Womens Health (Larchmt) 2019; 28:842-848. [PMID: 30855205 DOI: 10.1089/jwh.2018.7180] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yindi Zhang
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Yushu Li
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Yingxi Xu
- Department of Clinical Nutrition, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Chenyan Li
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Xiaochen Xie
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Yan Li
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Weiwei Wang
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Jinyuan Mao
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Weiping Teng
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang, P.R. China
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Shengnan HMD, Lin Y, Lili PMD, Zhao WMD, Ming-an YMD. Microwave Ablation of An Autonomous Functioning Thyroid Nodule in A Pregnant Patient: A Case Report. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2019. [DOI: 10.37015/audt.2019.190824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Yu Z, Han Y, Shen R, Huang K, Xu YY, Wang QN, Zhou SS, Xu DX, Tao FB. Gestational di-(2-ethylhexyl) phthalate exposure causes fetal intrauterine growth restriction through disturbing placental thyroid hormone receptor signaling. Toxicol Lett 2018; 294:1-10. [DOI: 10.1016/j.toxlet.2018.05.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/26/2018] [Accepted: 05/09/2018] [Indexed: 12/20/2022]
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Fraenkel M, Shafat T, Cahn A, Erez O, Novack V, Tsur A. Low thyroid-stimulating hormone and its persistence beyond the first trimester of pregnancy. Int J Gynaecol Obstet 2018; 142:270-276. [DOI: 10.1002/ijgo.12540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 04/13/2018] [Accepted: 05/30/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Merav Fraenkel
- Endocrinology; Soroka University Medical Center and the Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer Sheba Israel
| | - Tali Shafat
- Clinical Research Center; Soroka University Medical Center and the Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer Sheba Israel
| | - Avivit Cahn
- The Diabetes Unit, Endocrinology and Metabolism Unit; Hadassah Hebrew University Hospital; Jerusalem Israel
| | - Offer Erez
- Department of Obstetrics & Gynecology; Soroka University Medical Center and the Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer Sheba Israel
| | - Victor Novack
- Clinical Research Center; Soroka University Medical Center and the Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer Sheba Israel
| | - Anat Tsur
- Endocrinology; Clalit Health Services; Jerusalem Israel
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You SH, Cheng PJ, Chung TT, Kuo CF, Wu HM, Chu PH. Population-based trends and risk factors of early- and late-onset preeclampsia in Taiwan 2001-2014. BMC Pregnancy Childbirth 2018; 18:199. [PMID: 29855344 PMCID: PMC5984409 DOI: 10.1186/s12884-018-1845-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/23/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Preeclampsia, a multisystem disorder in pregnancies complicates with maternal and fetal morbidity. Early- and late-onset preeclampsia, defined as preeclampsia developed before and after 34 weeks of gestation, respectively. The early-onset disease was less prevalent but associated with poorer outcomes. Moreover, the risk factors between early -and late- onset preeclampsia could be differed owing to the varied pathophysiology. In the study, we evaluated the incidences, trends, and risk factors of early- and late- onset preeclampsia in Taiwan. METHODS This retrospective population-based cohort study included all ≧20 weeks singleton pregnancies resulting in live-born babies or stillbirths in Taiwan between January 1, 2001 and December 31, 2014 (n = 2,884,347). The data was collected electronically in Taiwanese Birth Register and National Health Insurance Research Database. The incidences and trends of early- and late-onset preeclampsia were assessed through Joinpoint analysis. Multivariate logistic regression was used to analyze the risk factors of both diseases. RESULTS The age-adjusted overall preeclampsia rate was slightly increased from 1.1%(95%confidence interval [CI], 1.1-1.2) in 2001 to 1.3% (95%CI, 1.2-1.3) in 2012 with average annual percentage change (AAPC) 0.1%/year (95%CI, 0-0.2%). However, the incidence was remarkably increased from 1.3% (95%CI, 1.3-1.4) in 2012 to 1.7% (95%CI, 1.6-1.8) in 2014 with AAPC 1.3%/year (95%CI,0.3-2.5). Over the study period, the incidence trend in late-onset preeclampsia was steadily increasing from 0.7% (95%CI, 0.6-0.7) in 2001 to 0.9% (95%CI, 0.8-0.9) in 2014 with AAPC 0.2%/year (95%CI, 0.2-0.3) but in early-onset preeclampsia was predominantly increase from 0.5% (95%CI, 0.4-0.5) in 2012 to 0.8% (95%CI, 0.8-0.9) in 2014 with AAPC 2.3%/year (95%CI, 0.8-4.0). Advanced maternal age, primiparity, stroke, diabetes mellitus, chronic hypertension, and hyperthyroidism were risk factors of preeclampsia. Comparing early- and late-onset diseases, chronic hypertension (ratio of relative risk [RRR], 1.71; 95%CI, 1.55-1.88) and older age (RRR, 1.41; 95%CI 1.29-1.54) were more strongly associated with early-onset disease, whereas primiparity (RRR 0.71, 95%CI, 0.68-0.75) had stronger association with late-onset preeclampsia. CONCLUSIONS The incidences of overall, and early- and late-onset preeclampsia were increasing in Taiwan from 2001 to 2014, predominantly for early-onset disease. Pregnant women with older age and chronic hypertension had significantly higher risk of early-onset preeclampsia.
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Affiliation(s)
- Shu-Han You
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Po-Jen Cheng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ting-Ting Chung
- Big data research office, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsien-Ming Wu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan.
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Huang HB, Kuo PL, Chang JW, Jaakkola JJK, Liao KW, Huang PC. Longitudinal assessment of prenatal phthalate exposure on serum and cord thyroid hormones homeostasis during pregnancy - Tainan birth cohort study (TBCS). THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 619-620:1058-1065. [PMID: 29734584 DOI: 10.1016/j.scitotenv.2017.11.048] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/23/2017] [Accepted: 11/04/2017] [Indexed: 06/08/2023]
Abstract
An increasing number of studies have revealed that phthalate exposure alters thyroid hormone homeostasis in the general population, but there is insufficient evidence of the effect of longitudinal maternal phthalate exposure on maternal and fetal thyroid hormones during pregnancy. We longitudinally assessed the effect of prenatal phthalate exposure in pregnant women on umbilical cord and maternal thyroid hormones at three trimesters during pregnancy. We recruited 98 pregnant women and collected urine and blood samples at three trimesters in an obstetrics clinic in Southern Taiwan from 2013 to 2014. We analyzed the concentrations of 11 urinary phthalate metabolites, including monoethylhexyl phthalate, mono-(2-ethyl-5-oxo-hexyl) phthalate (MEOHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP), mono-n-butyl phthalate, monoisobutyl phthalate (MiBP), monoethyl phthalate (MEP), using online liquid chromatography-tandem mass spectrometry. The cord and maternal serum levels of thyroxine (T4), free T4, triiodothyronine (T3), thyroid-stimulating hormone (TSH), and thyroxine-binding globulin were measured using an electrochemiluminescence immunoassay. A mixed-model analysis was utilized to assess the effect of longitudinal phthalate exposure on thyroid hormones and adjusted for significant covariates. We found that urinary MiBP (β=-0.065, 95% confidence interval (CI): -0.124, -0.005), and MEOHP (β=-0.083, 95% CI: -0.157, -0.009) were significantly negatively associated with serum TSH. Urinary MECPP was inversely related to serum T3 (β=-0.027, 95% CI: -0.047, -0.006). Urinary MEP (β=0.014, 95% CI: -0.001, 0.028) and MiBP (β=0.033, 95% CI: 0.018, 0.049) were positively related to free T4. We found that cord serum T3 (β=0.067, 95% CI: 0.003, 0.131) and free T4 (β=0.031, 95% CI: 0.001, 0.062) levels had significant positive associations with maternal ΣDBPm levels at the second trimester. We concluded that different phthalates exposure windows during gestation may alter cord and serum thyroid hormone homoeostasis.
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Affiliation(s)
- Han-Bin Huang
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Pao-Lin Kuo
- Department of Obstetric and Gynecology, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
| | - Jung-Wei Chang
- Research Center for Environmental Trace Toxic Substances, National Cheng Kung University, Tainan, Taiwan
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Kai-Wei Liao
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Po-Chin Huang
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
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Barjaktarovic M, Korevaar TIM, Chaker L, Jaddoe VWV, de Rijke YB, Visser TJ, Steegers EAP, Peeters RP. The association of maternal thyroid function with placental hemodynamics. Hum Reprod 2018; 32:653-661. [PMID: 28130433 DOI: 10.1093/humrep/dew357] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/23/2016] [Indexed: 12/22/2022] Open
Abstract
STUDY QUESTION What is the clinical association of maternal thyroid function with placental hemodynamic function? SUMMARY ANSWER A higher free thyroxine (FT4) concentration in early pregnancy is associated with higher placental vascular resistance. WHAT IS KNOWN ALREADY Suboptimal placental function is associated with preeclampsia (which, in turn, further deteriorates placental hemodynamics and impairs the fetal blood supply), fetal growth restriction and premature delivery. Studies have suggested that thyroid hormone (TH) has a role in placental development through effects on trophoblast proliferation and invasion. STUDY DESIGN, SIZE, DURATION This study was embedded in The Generation R cohort, a population-based prospective study from early fetal life onwards in Rotterdam, the Netherlands. In total, 7069 mothers with expected delivery date between April 2002 and January 2006 were enrolled during early pregnancy. PARTICIPANTS/MATERIALS, SETTING, METHOD Thyroid-stimulating hormone (TSH) and free thyroxine (FT4) concentrations were measured during early pregnancy (median 13.4 weeks, 95% range 9.7-17.6 weeks). Placental function was assessed by Doppler ultrasound via measurement of arterial vascular resistance, i.e. umbilical artery pulsatility index (PI) and uterine artery resistance index (RI) (both measured twice, between 18-25th and after 25th gestational weeks) and the presence of uterine artery notching (once after the 25th gestational week) in 5184 pregnant women. MAIN RESULTS AND THE ROLE OF CHANCE FT4 was positively linearly associated with umbilical artery PI in the second and third trimesters as well as with uterine artery RI in the second trimester and the risk of uterine artery notching in the third trimester (P < 0.05 for all). The association of thyroid function with preeclampsia and birth weight was partially mediated through changes in placental function, with the percentages of mediated effects being 10.4% and 12.5%, respectively. LIMITATIONS, REASONS FOR CAUTION A potential limitation is the availability of only a single time point for TH measurements and different numbers of missing placental ultrasound measurements for the adverse outcomes. WIDER IMPLICATIONS OF THE FINDINGS A higher FT4 concentration in early pregnancy is associated with higher vascular resistance in the second and third trimesters in both the maternal and fetal placental compartment. These effects on placental function might explain the association of FT4 with adverse pregnancy outcomes, including preeclampsia and fetal growth restriction. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a fellowship from ERAWEB, a project funded by the European Commission (to M.B.) and by clinical fellowship from The Netherlands Organization for Health Research and Development (ZonMw), Project 90700412 (to R.P.P.). The authors have no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Barjaktarovic
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus Medical Center, Dr Molewaterplein 50, Room Ee 502a, 3015 GE, Rotterdam, The Netherlands.,Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - T I M Korevaar
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus Medical Center, Dr Molewaterplein 50, Room Ee 502a, 3015 GE, Rotterdam, The Netherlands.,Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - L Chaker
- Department of Internal Medicine, Erasmus Medical Center, Dr Molewaterplein 50, Room Ee 502a, 3015 GE, Rotterdam, The Netherlands.,Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - V W V Jaddoe
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Y B de Rijke
- Department of Internal Medicine, Erasmus Medical Center, Dr Molewaterplein 50, Room Ee 502a, 3015 GE, Rotterdam, The Netherlands.,Department of Clinical Chemistry, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - T J Visser
- Department of Internal Medicine, Erasmus Medical Center, Dr Molewaterplein 50, Room Ee 502a, 3015 GE, Rotterdam, The Netherlands.,Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E A P Steegers
- Department of Obstetrics and Gynecology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - R P Peeters
- Department of Internal Medicine, Erasmus Medical Center, Dr Molewaterplein 50, Room Ee 502a, 3015 GE, Rotterdam, The Netherlands.,Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The Netherlands
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Yim CH. Thyroid dysfunction during pregnancy. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2018. [DOI: 10.5124/jkma.2018.61.4.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Chang Hoon Yim
- Department of Internal Medicine, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
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Korevaar TIM, Medici M, Visser TJ, Peeters RP. Thyroid disease in pregnancy: new insights in diagnosis and clinical management. Nat Rev Endocrinol 2017; 13:610-622. [PMID: 28776582 DOI: 10.1038/nrendo.2017.93] [Citation(s) in RCA: 219] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Adequate thyroid hormone availability is important for an uncomplicated pregnancy and optimal fetal growth and development. Overt thyroid disease is associated with a wide range of adverse obstetric and child development outcomes. An increasing number of studies now indicate that milder forms of thyroid dysfunction are also associated with these adverse pregnancy outcomes. The definitions of both overt and subclinical thyroid dysfunction have changed considerably over the past few years, as new data indicate that the commonly used fixed upper limits of 2.5 mU/l or 3.0 mU/l for thyroid-stimulating hormone (TSH) are too low to define an abnormal thyroid function. Furthermore, some studies now show that the reference ranges are not necessarily the best cut-off for identifying pregnancies at high risk of adverse outcomes. In addition, data suggest that thyroid peroxidase autoantibody positivity and high or low concentrations of human chorionic gonadotropin seem to have a more prominent role in the interpretation of thyroid dysfunction than previously thought. Data on the effects of thyroid disease treatment are lacking, but some studies indicate that clinicians should be aware of the potential for overtreatment with levothyroxine. Here, we put studies from the past decade on reference ranges for TSH, determinants of thyroid dysfunction, risks of adverse outcomes and options for treatment into perspective. In addition, we provide an overview of the current views on thyroid physiology during pregnancy and discuss strategies to identify high-risk individuals who might benefit from levothyroxine treatment.
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Affiliation(s)
- Tim I M Korevaar
- Department of Internal Medicine, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marco Medici
- Department of Internal Medicine, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Theo J Visser
- Department of Internal Medicine, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
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Zhang Y, Dai X, Yang S, Zhang C, Han M, Huang HF, Fan J. Maternal low thyroxin levels are associated with adverse pregnancy outcomes in a Chinese population. PLoS One 2017; 12:e0178100. [PMID: 28542464 PMCID: PMC5441606 DOI: 10.1371/journal.pone.0178100] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/06/2017] [Indexed: 12/21/2022] Open
Abstract
Although thyroid dysfunction in early pregnancy may have adverse effects on pregnancy outcomes, few studies have examined the relationship between maternal low free thyroxin (FT4) levels in both first and third trimesters of pregnancy and the incidence of adverse pregnancy outcomes. We hypothesized that low FT4 levels in either first or third trimesters of pregnancy may have different effects on pregnancy outcomes. The study included 6,031 mothers who provided both first and third pregnancy serum samples for analyses of thyroid function. Adverse pregnancy outcomes, such as gestational diabetes mellitus (GDM), pregnancy-induced hypertension and preeclampsia, were diagnosed using the oral glucose tolerance test, blood pressure and urine protein test. Serum metabolites like adenosine and its analogues were identified using hydrophilic interaction liquid chromatography (HILIC)-tandem mass spectrometry (MS/MS). The incidence of hypothyroidism in pregnant women tended to increase with age and pre-pregnancy body mass index (BMI). The incidence of GDM was negatively correlated with maternal FT4 levels during early pregnancy while the incidence of preeclampsia was negatively correlated with maternal FT4 levels during late pregnancy. The incidence of pregnancy-induced hypertension was not significantly correlated with maternal FT4 levels. The women who had isolated maternal hypothyroxemia (IMH) in the third trimester of pregnancy had an increased risk of developing preeclampsia. Some metabolites like adenosine and its analogues in the serum were significantly changed in pregnant mothers with IMH. In conclusion, low FT4 levels during pregnancy are a risk factor for GDM and preeclampsia. Adenosine and its analogues may be important bridges between IMH and preeclampsia.
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Affiliation(s)
- Yong Zhang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Embryo-Fetal Original Adult Disease Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaobei Dai
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuai Yang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chen Zhang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mi Han
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - He-Feng Huang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Embryo-Fetal Original Adult Disease Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianxia Fan
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Wang B, Liu JJ, Wang Y, Fu L, Shen R, Yu Z, Wang H, Chen YH, Zhang C, Meng XH, Xu DX. Maternal Fenvalerate Exposure Induces Fetal Intrauterine Growth Restriction Through Disrupting Placental Thyroid Hormone Receptor Signaling. Toxicol Sci 2017; 157:377-386. [DOI: 10.1093/toxsci/kfx052] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Johns LE, Ferguson KK, McElrath TF, Mukherjee B, Seely EW, Meeker JD. Longitudinal Profiles of Thyroid Hormone Parameters in Pregnancy and Associations with Preterm Birth. PLoS One 2017; 12:e0169542. [PMID: 28060899 PMCID: PMC5217954 DOI: 10.1371/journal.pone.0169542] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/18/2016] [Indexed: 01/07/2023] Open
Abstract
Introduction Overt thyroid disease in pregnancy is associated with numerous maternal and neonatal complications including preterm birth. Less is known about the contribution of trimester-specific subclinical alterations in individual thyroid hormones, especially in late gestation, on the risk of preterm birth. Herein, we examined the associations between subclinical changes in maternal thyroid hormone concentrations (TSH, total T3, free and total T4), measured at multiple time points in pregnancy, and the odds of preterm birth in pregnant women without clinical thyroid disease. Participants and Methods Data were obtained from pregnant women participating in a nested case-control study of preterm birth within on ongoing birth cohort study at Brigham and Women’s Hospital in Boston, MA (N = 439; 116 cases and 323 controls). We measured thyroid hormones in plasma collected at up to four time points in pregnancy (median = 10, 18, 26, and 35 weeks). We used multivariate logistic regression models stratified by study visit of sample collection to examine associations. To reveal potential biological pathways, we also explored these relationships by obstetric presentation of preterm birth (e.g., spontaneous preterm delivery) that have been previously hypothesized to share common underlying mechanisms. Results In samples collected at median 10 and 26 weeks of gestation, we found inverse associations between FT4 and the odds of overall preterm birth (odds ratio [OR] = 0.57, 95% confidence interval (CI) = 0.33, 1.00; and OR = 0.53, 95% CI = 0.34, 0.84, respectively). Positive associations were detected for total T3 at these same time points (OR = 2.52, 95% CI = 1.20, 5.31; and OR = 3.40, 95% CI = 1.56, 7.40, respectively). These effect estimates were stronger for spontaneous preterm birth. Conclusions Our results suggest that subclinical alterations in individual maternal thyroid hormones may influence the risk of preterm birth, and the strength of these associations vary by gestational age.
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Affiliation(s)
- Lauren E. Johns
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, United States
| | - Kelly K. Ferguson
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, United States
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States
| | - Thomas F. McElrath
- Division of Maternal and Fetal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Ellen W. Seely
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, United States
- * E-mail:
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Bucci I, Giuliani C, Napolitano G. Thyroid-Stimulating Hormone Receptor Antibodies in Pregnancy: Clinical Relevance. Front Endocrinol (Lausanne) 2017; 8:137. [PMID: 28713331 PMCID: PMC5491546 DOI: 10.3389/fendo.2017.00137] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 06/02/2017] [Indexed: 12/31/2022] Open
Abstract
Graves' disease is the most common cause of thyrotoxicosis in women of childbearing age. Approximately 1% of pregnant women been treated before, or are being treated during pregnancy for Graves' hyperthyroidism. In pregnancy, as in not pregnant state, thyroid-stimulating hormone (TSH) receptor (TSHR) antibodies (TRAbs) are the pathogenetic hallmark of Graves' disease. TRAbs are heterogeneous for molecular and functional properties and are subdivided into activating (TSAbs), blocking (TBAbs), or neutral (N-TRAbs) depending on their effect on TSHR. The typical clinical features of Graves' disease (goiter, hyperthyroidism, ophthalmopathy, dermopathy) occur when TSAbs predominate. Graves' disease shows some peculiarities in pregnancy. The TRAbs disturb the maternal as well as the fetal thyroid function given their ability to cross the placental barrier. The pregnancy-related immunosuppression reduces the levels of TRAbs in most cases although they persist in women with active disease as well as in women who received definitive therapy (radioiodine or surgery) before pregnancy. Changes of functional properties from stimulating to blocking the TSHR could occur during gestation. Drug therapy is the treatment of choice for hyperthyroidism during gestation. Antithyroid drugs also cross the placenta and therefore decrease both the maternal and the fetal thyroid hormone production. The management of Graves' disease in pregnancy should be aimed at maintaining euthyroidism in the mother as well as in the fetus. Maternal and fetal thyroid dysfunction (hyperthyroidism as well as hypothyroidism) are in fact associated with several morbidities. Monitoring of the maternal thyroid function, TRAbs measurement, and fetal surveillance are the mainstay for the management of Graves' disease in pregnancy. This review summarizes the biochemical, immunological, and therapeutic aspects of Graves' disease in pregnancy focusing on the role of the TRAbs in maternal and fetal function.
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Affiliation(s)
- Ines Bucci
- Unit of Endocrinology, Department of Medicine and Sciences of Aging, Ce.S.I.-Me.T., University of Chieti-Pescara, Chieti, Italy
- *Correspondence: Ines Bucci,
| | - Cesidio Giuliani
- Unit of Endocrinology, Department of Medicine and Sciences of Aging, Ce.S.I.-Me.T., University of Chieti-Pescara, Chieti, Italy
| | - Giorgio Napolitano
- Unit of Endocrinology, Department of Medicine and Sciences of Aging, Ce.S.I.-Me.T., University of Chieti-Pescara, Chieti, Italy
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Korevaar TIM, Steegers EAP, Chaker L, Medici M, Jaddoe VWV, Visser TJ, de Rijke YB, Peeters RP. The Risk of Preeclampsia According to High Thyroid Function in Pregnancy Differs by hCG Concentration. J Clin Endocrinol Metab 2016; 101:5037-5043. [PMID: 27648965 DOI: 10.1210/jc.2016-2397] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT During pregnancy, there is an increased demand for thyroid hormone. The pregnancy hormone human chorionic gonadotropin (hCG) is an important physiological stimulator of thyroid function. Already high-normal maternal free T4 concentrations are associated with a higher risk of preeclampsia. OBJECTIVE The objective of the investigation was to study our hypothesis that hCG concentrations can distinguish a physiological form of high thyroid function from a more pathological form of high thyroid function and that the risk of preeclampsia would differ accordingly. DESIGN TSH, free T4, hCG, or thyroperoxidase antibody concentrations were determined in pregnant women participating in a population-based prospective cohort study. SETTING The study was conducted in the general community. PARTICIPANTS A nonselected sample of 5146 pregnant women participated in the study. INTERVENTIONS There were no interventions. MAIN OUTCOME MEASURE(S) Preeclampsia was measured. RESULTS Women with high hCG-associated high thyroid function did not have a higher risk of preeclampsia than women with normal thyroid function. In contrast, women with low hCG and high thyroid function had a 3.4- to 11.1-fold higher risk of preeclampsia. These risk estimates were amplified in women with a high body mass index. Women with a low hCG and suppressed TSH (<0.10 mU/L) had a 3.2- to 8.9-fold higher risk of preeclampsia. hCG was not associated with preeclampsia, and results remained similar after exclusion of thyroperoxidase antibody-positive women. CONCLUSION This study suggests that, in contrast to women with a high hCG associated high thyroid function, women with low hCG and high thyroid function during pregnancy are at a higher risk of developing preeclampsia. The additional measurement of hCG may therefore help to distinguish a more pathological form of high thyroid function and women at a high risk of preeclampsia.
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Affiliation(s)
- Tim I M Korevaar
- The Generation R Study Group (T.I.M.K., E.A.P.S., M.M., V.W.V.J.) and Departments of Internal Medicine (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Obstetrics and Gynecology (E.A.P.S.), Pediatrics (V.W.V.J.), Epidemiology (V.W.V.J.), and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center and/or Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands; and Rotterdam Thyroid Center (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands
| | - Eric A P Steegers
- The Generation R Study Group (T.I.M.K., E.A.P.S., M.M., V.W.V.J.) and Departments of Internal Medicine (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Obstetrics and Gynecology (E.A.P.S.), Pediatrics (V.W.V.J.), Epidemiology (V.W.V.J.), and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center and/or Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands; and Rotterdam Thyroid Center (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands
| | - Layal Chaker
- The Generation R Study Group (T.I.M.K., E.A.P.S., M.M., V.W.V.J.) and Departments of Internal Medicine (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Obstetrics and Gynecology (E.A.P.S.), Pediatrics (V.W.V.J.), Epidemiology (V.W.V.J.), and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center and/or Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands; and Rotterdam Thyroid Center (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands
| | - Marco Medici
- The Generation R Study Group (T.I.M.K., E.A.P.S., M.M., V.W.V.J.) and Departments of Internal Medicine (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Obstetrics and Gynecology (E.A.P.S.), Pediatrics (V.W.V.J.), Epidemiology (V.W.V.J.), and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center and/or Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands; and Rotterdam Thyroid Center (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group (T.I.M.K., E.A.P.S., M.M., V.W.V.J.) and Departments of Internal Medicine (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Obstetrics and Gynecology (E.A.P.S.), Pediatrics (V.W.V.J.), Epidemiology (V.W.V.J.), and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center and/or Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands; and Rotterdam Thyroid Center (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands
| | - Theo J Visser
- The Generation R Study Group (T.I.M.K., E.A.P.S., M.M., V.W.V.J.) and Departments of Internal Medicine (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Obstetrics and Gynecology (E.A.P.S.), Pediatrics (V.W.V.J.), Epidemiology (V.W.V.J.), and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center and/or Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands; and Rotterdam Thyroid Center (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands
| | - Yolanda B de Rijke
- The Generation R Study Group (T.I.M.K., E.A.P.S., M.M., V.W.V.J.) and Departments of Internal Medicine (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Obstetrics and Gynecology (E.A.P.S.), Pediatrics (V.W.V.J.), Epidemiology (V.W.V.J.), and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center and/or Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands; and Rotterdam Thyroid Center (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands
| | - Robin P Peeters
- The Generation R Study Group (T.I.M.K., E.A.P.S., M.M., V.W.V.J.) and Departments of Internal Medicine (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Obstetrics and Gynecology (E.A.P.S.), Pediatrics (V.W.V.J.), Epidemiology (V.W.V.J.), and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center and/or Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands; and Rotterdam Thyroid Center (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands
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Johns LE, Ferguson KK, McElrath TF, Mukherjee B, Meeker JD. Associations between Repeated Measures of Maternal Urinary Phthalate Metabolites and Thyroid Hormone Parameters during Pregnancy. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:1808-1815. [PMID: 27152641 PMCID: PMC5089879 DOI: 10.1289/ehp170] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/13/2016] [Accepted: 04/27/2016] [Indexed: 05/18/2023]
Abstract
BACKGROUND Maintaining thyroid homeostasis during pregnancy is essential for normal fetal growth and development. Growing evidence suggests that phthalates interfere with normal thyroid function. Few human studies have investigated the degree to which phthalates may affect thyroid hormone levels in particularly susceptible populations such as pregnant women. OBJECTIVES We examined the associations between repeated measures of urinary phthalate metabolites and plasma thyroid hormone levels in samples collected at up to four time points per subject in pregnancy. Additionally, we investigated the potential windows of susceptibility to thyroid hormone disturbances related to study visit of sample collection. METHODS Data were obtained from pregnant women (n = 439) participating in a nested case-control study of preterm birth with 116 cases and 323 controls. We measured 9 phthalate metabolite concentrations in urine samples collected at up to four study visits per subject during pregnancy (median = 10, 18, 26, and 35 weeks of gestation, respectively). We also measured a panel of thyroid function markers in plasma collected at the same four time points per subject during pregnancy. RESULTS Although our results were generally null, in repeated measures analyses we observed that phthalate metabolites were largely inversely associated with thyrotropin and positively associated with free and total thyroid hormones. Cross-sectional analyses by study visit revealed that the magnitude and/or direction of these relationships varied by timing of exposure during gestation. CONCLUSIONS These results support previous reports showing the potential for environmental phthalate exposure to alter circulating levels of thyroid hormones in pregnant women. Citation: Johns LE, Ferguson KK, McElrath TF, Mukherjee B, Meeker JD. 2016. Associations between repeated measures of maternal urinary phthalate metabolites and thyroid hormone parameters during pregnancy. Environ Health Perspect 124:1808-1815; http://dx.doi.org/10.1289/EHP170.
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Affiliation(s)
- Lauren E. Johns
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kelly K. Ferguson
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Thomas F. McElrath
- Division of Maternal and Fetal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Address correspondence to J.D. Meeker, University of Michigan School of Public Health, Department of Environmental Health Sciences, 1835 SPH I, 1415 Washington Heights, Ann Arbor, MI 48109-2029 USA. Telephone: (734) 764-7184. E-mail:
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