Association between thyroid hormone parameters during early pregnancy and gestational hypertension: a prospective cohort study

Feasibility of using a multivariate serum biomarker model in early pregnancy to predict gestational hypertension

BackgroundWith the increasing need for early prediction and intervention of Pregnancy-Induced Hypertension (PIH), researchers have begun to explore the use of multiserum biomarker models to improve the accuracy and reliability of predictions. It is estimated that between 5% and 8% of pregnant women worldwide experience pregnancy-induced hypertension, which is one of the leading causes of maternal death and adverse neonatal outcomes. Given the potential negative impact of pregnancy-induced hypertension on maternal and infant health, early identification of high-risk individuals and appropriate preventive measures are particularly important.ObjectiveTo assess the feasibility of using a multivariate serum biomarker model in early pregnancy to predict gestational hypertension.MethodsRetrospective analysis was conducted on the clinical data of 125 pregnant women admitted to our hospital from January 2021 to December 2022. The occurrence of gestational hypertension was recorded and multiple serum biomarkers were collected and compared between the exposure and non-exposure groups. Logistic regression analysis was performed to identify influencing factors for gestational hypertension. Correlations between each factor and gestational hypertension were analyzed, and a line chart model was constructed. The discriminative ability of the model was evaluated using the C-index, and internal validation was conducted using ten-fold cross-validation and bootstrap validation.ResultsOut of 125 pregnant women, 35 (28.00%) developed gestational hypertension. β-HCG and Hcy were identified as independent risk factors, while PAPP-A, AFP, and uE3 were identified as independent protective factors. There was a positive correlation between Hcy, β-HCG, and gestational hypertension, and a negative correlation between PAPP-A, AFP, uE3, and gestational hypertension. The predictive line chart model had a C-index of 0.885 and an average AUC value of 0.853 after internal validation.Conclusionβ-HCG and Hcy are risk factors, while PAPP-A, AFP, and uE3 are protective factors for gestational hypertension. A line chart model based on these factors can help identify pregnant women at risk of developing gestational hypertension in early pregnancy.

Subclinical Hypothyroidism and Gestational Hypertensive Disorders in a Cohort of Romanian Pregnant Women with Gestational Diabetes Mellitus: A Pilot Study

OBJECTIVE

This study aimed to explore whether subclinical hypothyroidism (SCH) treated with levothyroxine in pregnancy complicated by gestational diabetes mellitus (GDM) is associated with an increased risk of gestational hypertensive disorders (GHDs) (gestational hypertension and preeclampsia).

METHODS

96 pregnant women with GDM were enrolled in this study and grouped as per the European Thyroid Association criteria into the SCH (n = 21) and euthyroid groups (n = 75). All subjects were tested for anthropometric parameters, maternal glucose homeostasis parameters, lipid levels, thyroid function tests, and blood pressure. All GDM pregnant women received nutritional and insulin therapy where needed, and the SCH group received levothyroxine treatment. Then, the maternal and newborn outcomes were compared. Data were analyzed using Student's t-test, Mann-Whitney U, and Chi-square tests wherever applicable. p values of <0.05 were considered significant.

RESULTS

Patients with GDM and SCH had a pre-pregnancy BMI and BMI at inclusion in the study smaller than those of the euthyroid group (p = 0.0004, p = 0.0009). There were no significant differences between groups regarding the incidence of GHD, preterm prelabor rupture of membranes (PPROMs), macrosomia, low birth weight, and fetal distress (p > 0.05). Patients with GDM and SCH treated with levothyroxine had more premature delivery than the euthyroid group (p = 0.03).

CONCLUSIONS

Subclinical hypothyroidism treated with levothyroxine in women with GDM does not increase the risk of gestational hypertensive disorders, but is associated with increased risk for prematurity.

Association between maternal thyroid function and risk of gestational hypertension and preeclampsia

OBJECTIVES

To investigate the influence of maternal level of thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) one by one or in combination on incidence of gestational hypertension and preeclampsia.

METHODS

The study included pregnant women (n=107) hospitalized in the period from July 1, 2020 to October 10, 2021 at the Department of Pathology of Pregnancy of the University Clinic of Obstetrics and Gynecology, University Clinical Center Sarajevo (UCCS) (Bosnia and Herzegovina), due to hypertensive disorder in pregnancy without symptoms of impaired thyroid function. In all patients fulfilling inclusion criteria TSH, FT3, and FT4 using electrochemiluminescence immunoassay (ECLIA, Roche Diagnostics, Basel, Switzerland) were checked. There were two groups of patients: one with gestational hypertension (G1) and the other with preeclampsia (G2). The programs SPSS for Windows 25.0, SPSS Inc, Chicago, IL, USA and Microsoft Excel 11, Microsoft Corporation, Redmond, WA, USA were used for statistical analysis using nonparametric Mann-Whitney U test because the distribution of the data was not normal. The result was considered statistically significant if p<0.05.

RESULTS

Gestational age at delivery (G2 36.86 ± 3.79 vs. G1 38.94 ± 2.15; p=0.002) and birth weight (G2 2,841.36 ± 1,006.39 vs. G2 3,290.73 ± 745.6; p=0,032) were significantly different between the investigated groups. The difference between the peak systolic (p=0.002), peak diastolic blood pressure (p=0.007), TSH (p=0.044), and FT3 (p=0.045) were statistically significant. Impaired thyroid function was observed more often in G2 than in G1.

CONCLUSIONS

Thyroid function was more often affected adversely in pregnancies complicated with preeclampsia than with gestational hypertension. Based on the results of our study it might be prudent to check thyroid hormones in all asymptomatic pregnancies with preeclampsia or gestational hypertension. These findings need confirmation in larger better designed prospective studies.

Thyroid Dysfunction among Hypertensive Pregnant Women in Warri, Delta State, Nigeria

The hypertensive pregnant woman is at a higher risk of complications either before, during or after birth and the baby can be adversely affected leading to preterm birth, low birth weight, placental separation (abruption) and other complications. The aim of the study was to evaluate thyroid dysfunction among pregnant women with hypertension. The study participants were 150 hypertensive pregnant women, 25 non-hypertensive pregnant women and 25 non-hypertensive non-pregnant women. Exactly 5mL of blood was collected and used for the assay of triiodothyronine (T3), thyroxine (T4) and thyroid-stimulating hormone (TSH) using the enzyme-linked immunosorbent assay technique. Data were analyzed using appropriate statistical tools. The results showed a significantly higher (p < 0.05) age among hypertensive pregnant women when compared with non-hypertensive pregnant women and non-hypertensive non-pregnant women. The serum TSH was significantly higher (p < 0.035) among hypertensive pregnant women when compared with non-hypertensive pregnant women. The triiodothyronine (T3) of hypertensive pregnant women was observed to be significantly higher (p < 0.05) when compared with both non-hypertensive pregnant women and non-hypertensive non-pregnant women. Some 15/150 (10%) of hypertensive pregnant women had subclinical hypothyroidism, 13/150 (8.7%) had overt hypothyroidism, while 122/150 (81.3%) were euthyroid. Among those with thyroid dysfunction, five and four of the subjects had subclinical hypothyroidism and overt hypothyroidism during the second trimester, while ten and nine had subclinical hypothyroidism and overt hypothyroidism during the third trimester, respectively. Evaluation of hypertensive pregnant women for thyroid function may be routinely performed to enable early diagnosis and treatment.

Relationship Between Subclinical Hypothyroidism in Pregnancy and Hypertensive Disorder of Pregnancy: A Systematic Review and Meta-Analysis

OBJECTIVE

Studies have shown a high incidence of subclinical hypothyroidism in pregnancy, but the adverse pregnancy outcomes caused by it are not clear. Therefore, we conducted a systematic review and meta-analysis to evaluate the relationship between subclinical hypothyroidism in pregnancy and hypertensive disorders of pregnancy(HDP) to guide clinical practice.

METHOD

We searched the MEDLINE (PubMed), Cochrane Central, EMBASE, Web of Science, and SCOPUS databases and screened all studies evaluating the relationship between subclinical hypothyroidism in pregnancy and hypertensive disorders of pregnancy. Two researchers independently evaluated the quality of all eligible original studies using the Newcastle-Ottawa Scale (NOS). We also performed a meta-analysis using STATA15.1. Sensitivity analyses were also performed by examining the effects of individual studies as well as using different effect models and detecting any publication bias using the harbord test.

RESULTS

Twenty-two studies were included in the final meta-analysis. Our results indicated that pregnant women with subclinical hypothyroidism had an increased risk of HDP (OR = 1.54(95% CI: 1.21-1.96) I²=67.1%), compared with euthyroidism. Subclinical hypothyroidism in pregnancy was not associated with hypertensive disorders of pregnancy at TSH diagnostic cut-off of less than 3.0 mIU/L (P = 0.077). Curiously, the risk of HDP increases when the TSH diagnostic cut-off value is higher or lower than 4 mIU/L. Although only 9 studies were above the threshold, the risk of developing HDP was still 1.69 times, which was highest in all subgroup analyses. This is consistent with the newly recommended diagnostic cut-off value of 4 mIU/L for TSH by the ATA. Our results consider that the risk of hypertensive disorder complicating pregnancy is increased regardless of the diagnosis of subclinical hypothyroidism at any stage of pregnancy. Unfortunately, there is insufficient evidence to support that patients can benefit from treatment with levothyroxine.

CONCLUSION

The results of this meta-analysis indicate that subclinical hypothyroidism in pregnancy is associated with an increased risk of developing HDP, and this association exists regardless of the gestational period. However, the available evidence cannot support these patients receiving thyroxine intervention can benefit from it, so routine screening is only recommended for pregnant women with risk factors for hypothyroidism. Further research is needed to validate more scientific and rigorous clinical studies to clarify the relationship between subclinical hypothyroidism and HDP to improve patient prognosis.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, PROSPERO (CRD42021286405).

Impact of TPOAb-negative maternal subclinical hypothyroidism in early pregnancy on adverse pregnancy outcomes

PURPOSE

To investigate the effect of subclinical hypothyroidism on pregnancy outcomes of women early in their pregnancy with different thyroid-stimulating hormone levels and thyroid peroxidase antibody-negative status and to explore reasonable thyroid-stimulating hormone levels for subclinical hypothyroidism in early pregnancy.

METHODS

A total of 2378 women early in their pregnancy were studied retrospectively. The baseline characteristics were collected from medical records. Pregnancy outcomes were compared between the euthyroidism and subclinical hypothyroidism groups that were diagnosed by 2011 or 2017 American Thyroid Association guidelines. In addition, the effect of different maternal thyroid-stimulating hormone levels on adverse pregnancy outcomes was analyzed using binary logistic regression.

RESULTS

According to the 2011 American Thyroid Association diagnostic criteria of subclinical hypothyroidism, the prevalence of pregnancy outcomes was not significantly higher in the subclinical hypothyroidism group than in the euthyroidism group. However, pregnant women with subclinical hypothyroidism identified by the 2017 American Thyroid Association criteria had a higher risk of premature delivery (odds ratio = 3.93; 95% confidence interval = 1.22-12.64), gestational diabetes mellitus (odds ratio = 2.69; 95% confidence interval = 1.36-5.32), and gestational anemia (odds ratio = 3.28; 95% confidence interval = 1.60-6.75). Moreover, no differences in the prevalence of adverse pregnancy outcomes were observed between the mildly elevated thyroid-stimulating hormone group (2.5 < thyroid-stimulating hormone ⩽4.0 mIU/l) and the normal thyroid-stimulating hormone group (0.27 < thyroid-stimulating hormone ⩽2.5 mIU/l). The significantly elevated thyroid-stimulating hormone group (4.0 < thyroid-stimulating hormone < 10.0 mIU/l) had a higher prevalence of premature delivery, gestational diabetes mellitus, and gestational anemia than the normal thyroid-stimulating hormone group, even after controlling for potential confounding factors.

CONCLUSION

A mildly elevated thyroid-stimulating hormone level or maternal subclinical hypothyroidism diagnosed by 2011 American Thyroid Association guidelines during early pregnancy in thyroid peroxidase antibody-negative women was not associated with adverse pregnancy outcomes. However, maternal subclinical hypothyroidism identified by the 2017 American Thyroid Association guidelines increased the risks of several adverse pregnancy outcomes in women untreated with levothyroxine. The 2017 American Thyroid Association guidelines could be more reasonable for the diagnosis of subclinical hypothyroidism in southern China.

Urinary iodine as an important indicator for preeclampsia: a Polish perspective

Preeclampsia (PE) is one of the leading causes of perinatal and maternal morbidity. Although subclinical hypothyroidism in pregnancy is one of the established risk factors for PE, the link between iodine deficiency and PE is not fully understood. The aim of our study was to assess urinary iodine concentration (UIC), serum thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) levels in Polish women with PE (PE group, n=78) compared with healthy non-pregnant women (CNP group, n=30), and healthy pregnant women (CP group, n=46). The UIC was determined by inductively coupled plasma mass spectrometry (ICP-MS). Both the mean UIC of 144.6±36.4 μg/L in the CP group and the mean of 125.8±33.6 μg/L in the PE group, respectively, were lower compared to non-pregnant women (149.8±28.8 μg/L), and the difference between the PE and CNP groups was statistically significant. TSH values were the highest in the PE group, while the lowest average level was for the CNP group. The fT3 and fT4 values in the PE group were significantly lower compared to the CNP and CP groups. Despite iodine supplementation during pregnancy, the UIC was lower compared to non-pregnant women, while in women with PE it was at a significantly lower level. To reduce the incidence of possible health complications, proper iodine supplementation and monitoring of the UIC is recommended for pregnant women suffering from PE or at risk of developing PE.