Prevalence of hypothyroidism in pregnancy: An epidemiological study from 11 cities in 9 states of India

The Spectrum of Thyroid Dysfunction During Pregnancy and Fetomaternal Outcome, A Study from the Premier Institute of Western India

Background

Thyroid dysfunction evaluation during pregnancy is important for the mother's health, obstetric outcomes, and the child's cognitive development. This study is conducted to know various thyroid disorders that can occur during antenatal and their impact on mother and fetus outcomes.

Materials and Methods

This observational research was conducted over two years at a tertiary center in Western Rajasthan, India. Seven hundred and seventy-two low-risk singleton pregnant patients who met the inclusive criteria were recruited. The estimation of T3, T4, and TSH was done along with a routine investigation in antenatal women. Antenatal having abnormal thyroid profiles were then analyzed for mother and fetus problems.

Results

The prevalence of thyroid dysfunction in antenatal women is 16.5%. Subclinical hypothyroidism (SCH) was seen in 12.5% of cases, overt hypothyroidism in 3.36%, and subclinical hyperthyroidism in only 0.51% of cases. Anti-TPO was positive in 46 (41.44%) women with hypothyroidism and 1 (25%) with hyperthyroidism. Compared to euthyroid women, women with overt hypothyroid (19.23% vs 3.1%, P = 0.002) and subclinical hypothyroid (9.27% vs 3.1%, P = 0.003) were found to be associated with a higher risk of hypertensive disease. Concerning fetal outcomes. There was a high risk for preterm (12.37% v/s 4.9%, P = 0.004) and fetal growth retardation (FGR) in patients with SCH (7.21% v/s 3.1%, P = 0.04).

Conclusion

Considering the significant influence of thyroid disorders on mother and fetus outcomes, the screening for thyroid during pregnancy should be considered universally, particularly in developing countries with high prevalent rates, such as India.

Effects of treating subclinical hypothyroidism in pregnancy in India: Are we treating too many for little gain? A retrospective cohort study

OBJECTIVE

To assess the impact of treatment of subclinical hypothyroidism (SCH) on short-term pregnancy outcomes.

METHOD

Data from 4526 consecutive women with singleton pregnancies who delivered between January 2015 and December 2017 were analyzed. SCH was defined as a thyroid-stimulating hormone (TSH) level between 2.5 and 10 mU/mL with normal free thyroxine. Of those with SCH, some were treated but others were not. These two groups were compared using χ2 and Student t tests for categorical and continuous variables, respectively. Multiple logistic regression models, adjusted for maternal age, body mass index, parity, gestation at TSH measurement, and gestational diabetes mellitus status, were used to investigate the effect of treatment on pregnancy and neonatal outcomes.

RESULTS

In all, 1227 (27.1%) of 4526 women had SCH, of whom 393 (32.0%) were treated. The mean age and body mass index were similar in both groups. The mean gestation at measuring of TSH was 11.7 ± 6.5 weeks. There was no significant difference in pregnancy or neonatal outcomes between the two groups. A sub-group analysis when SCH was defined as TSH 4.0 mU/mL or greater showed a higher rate of large for gestational age and lower rates of low birth weight and small for gestational age in the treated group.

CONCLUSIONS

The prevalence of SCH based on the international guidelines threshold is high in India. Treatment of SCH did not show any difference in pregnancy and neonatal outcomes in this study.

Thyroid status in pregnancy: Comparison of thyroid function abnormalities in women with and without a history of miscarriage or stillbirth

Objective

To evaluate thyroid function tests (TFTs) during pregnancy in women with previous history of miscarriage or stillbirth.

Methods

A cross-sectional study was carried out at the department of Obstetrics & Gynaecology and Endocrinology, Lady Reading Hospital, Peshawar from February 2021 to March 2022. All multigravida women attending the antenatal clinics were included using consecutive sampling. These women were placed into two groups, Group-A comprised of women with no prior history of miscarriages or stillbirths, and those with a history of foetal death during previous pregnancies were assigned Group-B. Free T4, thyroid stimulating hormone (TSH) and anti-thyroid peroxidase (TPO) antibodies were measured and the former two were used to label patients with thyroid dysfunction.

Results

A total of 139 multigravida women were included in the study. About 43% of the women had a history of miscarriages or stillbirths. Thyroid dysfunction was observed overall in 36.69 % women, of whom 25.18% had sub-clinical hypothyroidism, 6.47% had hypothyroidism and 5.04 % were sub-clinical hyperthyroid. Women in Group-B had more thyroid functions abnormalities compared to Group-A (p<0.05). Moreover, there was significant difference in median TSH and freeT4 between the groups (p<0.001). Overall, thyroid dysfunction was found in 66.67% of patients who had a history of foetal death.

Conclusions

In pregnant women with a history of miscarriage or abortion, thyroid functions abnormalities are common therefore routine thyroid testing is advised in pregnant women to prevent adverse perinatal outcomes.

Early treatment will prevent feto-maternal complications in thyroid disorders during pregnancy: A prospective study

Context

Associations between adverse maternal complications and fetal outcomes are known entity in thyroid disorders during pregnancy. Thus, prompt identification of thyroid disorders and timely initiation of treatment is essential. Universal screening and early treatment of pregnant women for thyroid disorder should be considered especially in a resource-limited country like India with a high prevalence of undiagnosed thyroid disorders and adverse feto-maternal outcomes.

Aims

Early treatment will prevent feto-maternal complications in thyroid disorders in pregnant females visiting outpatient department in tertiary care hospital in rural settings.

Settings and Design

This study was conducted in a tertiary care rural-based medical college with participation from departments of Obstetrics and Gynaecology, Medicine, and ENT.

Methods and Material

Expectant mothers in first trimester who had urine pregnancy test positive in outpatient clinic were included after a written informed consent. Detailed history and examination was done. TSH was done if abnormal-FT3 and FT4 were done. All thyroid disorders were treated according to American Thyroid Association (ATA) 2017 guideline. All pregnancies were followed up for maternal complications and fetal outcomes.

Statistical Analysis Used

Data from the performa were entered in Office Excel and analysis was performed using STATA (14.2). Descriptive statistics (mean [standard deviation], Frequency [%], etc.) were used to depict profile of study participants, prevalence of thyroid dysfunction, and outcome measures. Chi-square test was employed to assess the association between thyroid dysfunction and various maternal and fetal outcomes. A P value less than. 05 was considered statistically significant.

Results

Of 350 pregnant females, 83 (23.5%) pregnant females had thyroid disorder. Of which, 33 (9.4%) had subclinical hypothyroidism, 37 (10.5%) had overt hypothyroidism, 11 (3.1%) had subclinical hyperthyroidism, and two (0.5%) had hyperthyroidism. The prevalence of hypothyroidism in pregnancy increases with increasing age (P value. 001) and not associated with parity, abortion, and consumption of iodized salt. Total patients with feto-maternal outcome follow-up were 241. Pre-eclampsia (P value. 004) was a significant complication in hypothyroid mothers. There was no significant difference in the rate of cesarean section and preterm delivery in hypothyroid and euthyroid mothers. Neonatal outcomes showed more trends of abortion, fetal demise, and IUFD in the hypothyroid group, although not statistically significant. (P value. 07).

Conclusions

Due to the high prevalence of thyroid disorders during pregnancy, universal screening of thyroid disorders should be done in early pregnancy instead of high-risk screening. Early detection and early treatment in the first 10 weeks of pregnancy help to prevent maternal and fetal complications of thyroid disorders in pregnancy. Pre-eclampsia is to be monitored in treated pregnant females with hypothyroidism.

Burden, risk factors and outcomes associated with adequately treated hypothyroidism in a population-based cohort of pregnant women from North India

Hypothyroidism is the commonest endocrine disorder of pregnancy, with known adverse feto-maternal outcomes. There is limited data on population-based prevalence, risk factors and outcomes associated with treatment of hypothyroidism in early pregnancy. We conducted analysis on data from an urban and peri-urban low to mid socioeconomic population-based cohort of pregnant women in North Delhi, India to ascertain the burden, risk factors and impact of treatment, on adverse pregnancy outcomes- low birth weight, prematurity, small for gestational age and stillbirth. This is an observational study embedded within the intervention group of the Women and Infants Integrated Interventions for Growth Study, an individually randomized factorial design trial. Thyroid stimulating hormone was tested in 2317 women in early (9-13 weeks) pregnancy, and thyroxin replacement started hypothyroid (TSH ≥2.5mIU/mL). Univariable and multivariable generalized linear model with binomial family and log link were performed to ascertain risk factors associated with hypothyroidism and association between hypothyroidism and adverse pregnancy outcomes. Of 2317 women, 29.2% (95% CI: 27.4 to 31.1) had hypothyroidism and were started on thyroxin replacement with close monitoring. Overweight or obesity was associated with increased risk (adjusted RR 1.29, 95% CI 1.10 to 1.51), while higher hemoglobin concentration was associated with decreased risk (adjusted RR 0.93, 95% CI 0.88 to 0.98 for each g/dL) for hypothyroidism. Hypothyroid women received appropriate treatment with no increase in adverse pregnancy outcomes. Almost a third of women from low to mid socio-economic population had hypothyroidism in early pregnancy, more so if anemic and overweight or obese. With early screening and adequate replacement, adverse pregnancy outcomes may be avoided. These findings highlight the need in early pregnancy for universal TSH screening and adequate treatment of hypothyroidism; as well as for attempts to reduce pre and peri-conception overweight, obesity and anemia. Clinical trial registration: Clinical trial registration of Women and Infants Integrated Interventions for Growth Study Clinical Trial Registry-India, #CTRI/2017/06/008908; Registered on: 23/06/2017, (http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=19339&EncHid=&userName=society%20for%20applied%20studies).

Non-alcoholic Fatty Liver Disease in Overt Hypothyroidism: A Cross-Sectional Study in a Tertiary Care Hospital

BACKGROUND

 The term non-alcoholic fatty liver disease (NAFLD) describes a condition in which excess fat accumulates in the liver, similar to alcohol-induced liver injury but affecting those who don't consume alcohol. Liver steatosis may vary from simple hepatic steatosis to more serious conditions, including non-alcoholic steatohepatitis and cirrhosis, and is linked to an increased risk of hepatocellular carcinoma (HCC). There is an estimated 20-30% prevalence of non-alcoholic fatty liver disease over the globe. The incidence rate among Indians is 26.9%. Metabolic diseases like insulin resistance, obesity, type-2 diabetes mellitus, and dyslipidemia are risk factors for NAFLD. A correlation between overt hypothyroidism and NAFLD has been discussed.

OBJECTIVES

 To determine the magnitude of non-alcoholic fatty liver disease in overt hypothyroidism and to estimate the clinical and biochemical profile of patients with overt hypothyroidism and its relationship.

METHODS

Throughout the course of a year, researchers from the medical department of a large hospital in southern India collected data in a cross-sectional observational study. Thyroid profile, fasting lipid profile, liver function tests, and ultrasound of the abdomen and pelvis were administered to a total of 100 male and female patients (18-60 years old) with newly diagnosed overt hypothyroidism who were visiting the outpatient department (OPD) and hospitalized in wards of general medicine.

RESULTS

About 75% of subjects were females, with a mean age of 37.63±7.6 years and a mean body mass index (BMI) of 25.07±1.5 kg/m². A significant correlation was found between dyslipidemia and thyroid-stimulating hormone (TSH) levels (p-value <0.001), and between dyslipidemia and ultrasonogram (USG) finding of NAFLD (p-value <0.001). A significant correlation was seen between TSH values and NAFLD findings (p-value <0.001).

CONCLUSION

NAFLD is a risk factor for developing hepatocellular carcinoma and is a known contributor to cryptogenic cirrhosis. Hypothyroidism is being studied as one of the causes of NAFLD. When hypothyroidism is diagnosed and treated early, it may reduce the likelihood of NAFLD and associated consequences.

Prevalence and Complications of Subclinical and Overt Hypothyroidism in Pregnancy at North Indian Tertiary Care Center

Background

Thyroid disorders are one of the commonest endocrine problems among pregnant women. It is often argued that it is not only overt, but subclinical thyroid dysfunction also has similar adverse effects on maternal and fetal outcomes. There is a huge deficiency of data from the Indian population to assess the prevalence of thyroid dysfunction in pregnancy. This study aimed to determine the prevalence of thyroid disorders in pregnancy and their impact on obstetrical outcomes in the Indian population. The study also had the objective of finding a correlation between maternal and fetal thyroid-stimulating hormone (TSH) levels in hypothyroid pregnancies.

Materials and Methods

Around 1055 pregnant women in the first and second trimesters were enrolled in the study. A detailed history was noted and general examinations were done. Apart from routine obstetrical investigations, TSH level estimation was done. If the TSH level was deranged, then free T4 (fT4) and free T3 (fT3) levels were also estimated. Furthermore, 50 hypothyroid and euthyroid pregnant women from the same cohort were followed till delivery. Their obstetrical and perinatal outcomes were noted.

Results

The prevalence of thyroid dysfunction was 36.5% in this study, which was quite high in the population. Moreover, hypothyroid groups were prone to have pregnancy-induced hypertension (P = 0.03), intrauterine growth restriction (P = 0.05), and preterm delivery (P = 0.04) as compared to control. Cesarean section rate for fetal distress was significantly higher among pregnant hypothyroid women (P = 0.05). Neonatal respiratory distress and low appearance, pulse, grimace, activity, and respiration (APGAR) () scores were significantly more in the hyperthyroidism group (P = 0.04 and P = 0.02, respectively). Maternal TSH was significantly correlated with hemoglobin levels, HbA1c, and systolic blood pressure.

Conclusions

Significant adverse effects on maternal and fetal outcomes were seen emphasizing the importance of routine antenatal thyroid screening.

Hypothyroidism in Pregnancy: An Alarming Concern in a Rural Community of Eastern India

Introduction

Hypothyroidism exerts a multitude of effects on pregnant women and newborns. This study aimed to estimate the prevalence of hypothyroidism and its associated factors among pregnant women.

Material and Methods

This cross-sectional study was done at a community health center in Tangi, Eastern India. A total of 436 pregnant women ≤24 weeks gestation attending the ante-natal clinic were recruited by consecutive sampling after obtaining written informed consent. Those who were a known case of any psychiatric disorder and were not able to comprehend interview questions were excluded. Estimation of serum thyroid stimulating hormone levels was done at the central laboratory of the All India Institute of Medical Sciences, Bhubaneswar. Analysis was done using STATA 17.0 and presented as means or proportions. The association of hypothyroidism with various sociodemographic factors was analyzed with bivariate logistic regression.

Results

Mean age of the study participants was 23.9 years (SD: 3.65). About 31.4% of participants were found to have hypothyroidism. On bivariate logistic regression, the presence of hypothyroidism was not associated with any variable.

Conclusions

Hypothyroidism is widely prevalent in pregnant females in rural India. Screening of high-risk pregnant females followed by appropriate management is essential.

Pregnancy hypothyroidism incidence and complications using the 2011 and 2017 ATA cutoff values. Experience at a maternity hospital in a densely populated area in Mexico City

OBJECTIVES

Normal thyroid activity has an essential role in fetal development, its deficiency may hamper fetal neurodevelopment and neonatal growth. The quantitation of thyroid hormones although useful, still exposes differences on cut off levels to diagnose thyroid deficit accurately that can elicit under or over diagnosis of thyroid dysfuntion.

METHODS

A total of 839 pregnant patients were studied for thyroidal clinical assessment through quantitation of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) circulating levels. Patients evaluated for prenatal and neonatal outcomes. Thyroid function deficiencies were determined with the American Thyroid Association (ATA) 2011 and 2017 values. Statistical analysis searched for associations between variables, odds ratios (OR) and correlations were calculated to evaluate the reliability of the cutoff values recommended by the ATA.

RESULTS

Mean age of our cases was 27.5 + 5.83 years at diagnosis, mean gestational age at first consultation was 23.8 + 10.5 weeks. Mean TSH levels detected were: 2.5 + 1.89 mIU/L, total T3: 3.55 + 4.1 ng/dL, FT4: 3.14 + 4.4 ng/dL. The ATA 2011 values yielded 332 hypothyroidism cases vs. 507 euthyroid patients, a total incidence of 39.6% vs. the ATA 2017 values, diagnosing 100 hypothyroidism cases and 739 euthyroid patients, total incidence of 11.9%. Association with complications were not significant.

CONCLUSIONS

Using ATA 2017 values showed a decreased population with gestational hypothyroidism, hence preventing overdiagnosis and over-treatment. No significant complications were associated, requiring the determination of new regional values. Education and sensibilization of our population is needed to comply with early prenatal consultation and thyroid function testing.

Prevalence of Subclinical Hypothyroidism in Pregnancy and Its Association With Anti-thyroperoxidase Antibody and the Occurrence of Gestational Diabetes Mellitus

Introduction Subclinical hypothyroidism (SCH) and gestational diabetes mellitus (GDM) are common endocrinological abnormalities associated with pregnancy. The presence of a raised anti-thyroperoxidase (anti-TPO) antibody titer increases the risk of progression of subclinical hypothyroidism to overt hypothyroidism. Subclinical hypothyroidism and GDM are known to affect maternal and fetal outcomes adversely. A few studies have shown an increased risk of GDM with autoimmune hypothyroidism. However, data regarding this association between GDM, SCH, and anti-TPO Ab are scarce. This study aimed to find the prevalence of autoimmune subclinical hypothyroidism and its association with GDM in pregnancy. Materials and methods In a cross-sectional study, 382 pregnant women at their first antenatal checkup (ANC) were enrolled in the study. Serum thyroid-stimulating hormone (TSH), free T4 (FT4), anti-TPO Ab, and the 75 g oral glucose tolerance test (OGTT) were evaluated. The results obtained were analyzed in Systat Version 13.2 (SPSS Inc., Chicago, IL). Observations Results showed an SCH prevalence of 37.69% with a raised anti-TPO Ab titer in 49.31% of the diagnosed SCH cases, pointing towards an autoimmune etiology. Our study revealed a GDM prevalence of 12.04%. Out of the 46 GDM cases, 16 were found to have SCH and 3 cases had raised anti-TPO Ab titers. In our study, 27.73% of euthyroid pregnant women had a raised anti-TPO Ab titer. Our study revealed no significant association between GDM, SCH, and raised anti-TPO Ab titer. Conclusion Anti-TPO antibody subsequently leads to hypothyroxinemia, for which it is necessary that cases with high titer of anti-TPO antibody though euthyroid should be meticulously followed up and screened for to detect development of hypothyroidism or SCH, particularly in future pregnancies. However, GDM prevalence was at par with the national figure, but with no significant association of SCH and a high anti-TPO ab titer was found with GDM in our study. Further studies with a larger cohort may establish a causal association between the two most common endocrinological disorders observed in pregnancy.

The Prevalence of Subclinical Hypothyroidism During Early Pregnancy in Pakistan: A Cross-Sectional Study

Introduction Subclinical hypothyroidism (SCH) during early pregnancy is associated with an increased risk of miscarriage or premature birth. In Pakistan, the prevalence of SCH among pregnant women is not well documented. This multi-center study aims at identifying the prevalence of SCH among Pakistani pregnant women. Methods A cross-sectional multi-center study was conducted over a period of 12 months. Pregnant females in the first trimester of pregnancy were recruited from the antenatal clinics of seven centers from six Pakistani cities. We assessed the frequency of SCH in pregnant females and associated risk factors. Results A total of 500 pregnant women were enrolled in this study. Only eight women (1.6%) had a newly-diagnosed SCH. While 1.2% of women had hyperthyroidism, 6% had known hypothyroidism, and 1% had overt hypothyroidism. Ten females (33.3%) with known hypothyroidism were receiving an inadequate dose of thyroid replacement therapy. The association between BMI and SCH was not statistically significant (p = 0.69). Moreover, we could not find any significant difference between patients with or without SCH in terms of age (p > 0.90), dyslipidemia (p = 0.157), history of miscarriage (p > 0.90), the regularity of the cycle (p > 0.90), and history of infertility (p > 0.90). Conclusions The frequency of undiagnosed SCH in pregnant females in the study from Pakistan was 1.6%. The rate of uncontrolled hypothyroidism was high, which raises an alarm of the potential risks of untreated thyroid disorder.

Early postnatal hypothyroidism reduces juvenile play behavior, but prenatal hypothyroidism compensates for these effects

Perinatal hypothyroidism causes long-lasting effects on behavior, including hyperactivity, cognitive delays/deficits, and a reduction in anxiety. Although there is some evidence that hypothyroidism during fetal development in humans has been associated with later autism spectrum disorder diagnosis or autism-like traits, the relationships between early thyroid hormones and social behaviors are largely unknown. Previously, we found that a moderate dose of the hypothyroid-inducing drug methimazole during embryonic and postnatal development dramatically increased juvenile play in male and female rats. The goal of the current study was to determine the extent to which thyroid hormones act in prenatal or postnatal development to organize later social behaviors. Subjects were exposed to methimazole in the drinking water during prenatal (embryonic day 12 to birth), postnatal (birth to postnatal day 23), or pre- and postnatal development; control animals received regular drinking water throughout the experiment. They were tested for play behavior as juveniles (P30-32). We found an interaction between pre- and postnatal methimazole administration such that postnatal hypothyroidism decreased some play behaviors, whereas sustained pre- and postnatal hypothyroidism restored play to control levels. The effects were similar in males and females. To our knowledge, this is the first report of an interaction between pre- and postnatal hypothyroidism on later behavior. The complexity of the timing of these effects may help explain why epidemiological studies have not consistently found a relationship between gestational hypothyroidism and later behavior.

Hearing outcome in infants following correction of maternal hypothyroidism during pregnancy

PURPOSE

There is significant prevalence of overt and subclinical hypothyroidism in pregnant women in rural areas. Maternal hypothyroidism is known to cause congenital hypothyroidism resulting in sensorineural hearing loss. Anti-Thyroperoxidase antibodies are known to cross placental barrier. There is no literature on hearing assessment in infants born to women whose hypothyroidism was corrected during pregnancy. Do these infants suffer hearing loss? Our study addresses this question.

METHODS

140 infants born to women on treatment for hypothyroidism during pregnancy and 140 infants born to euthyroid women were evaluated for hearing by Brainstem Evoked Response Audiometrry at 1 and 4 months age. Anti-TPO antibodies were estimated at 4 months of age.

RESULTS

There was no clinical hearing deficit or delay in neurological development in infants born to women undergoing treatment for hypothyroidism during pregnancy. However wave V latency on BERA was slightly prolonged in them compared to infants born to euthyroid women. There was absence of wave V when maternal subclinical hypothyroidism persisted till parturition. However within 6-8months of age the wave V latencies corrected to normal. Anti-TPO antibodies were within normal range at 4months age.

CONCLUSION

Maternal hypothyroidism when corrected before parturition does not affect hearing in the infants clinically. The mild delay in wave V on BERA corrects within first year of life. However larger studies to assess hearing in infants born to women having overt hypothyroidism during first trimester of pregnancy may be desirable to assess whether hearing is adversely affected in them.

Development of a brief psychological intervention for perinatal depression (BIND-P)

BACKGROUND

Lack of recognition in national programs, poor referral system, and non-availability of trained human resources are the important barriers for the delivery of perinatal depression (PND) services in low- and middle-income countries (LAMICs). To address this there is an urgent need to develop an integrative and non-specialist-based stepped care model. As part of its research thrust on target areas of India's National Mental Health Programme (NMHP), the Indian Council of Medical Research funded a research project on the outcome of PND at four sites. In this article, we describe the development of the primary health care worker-based stepped care model and brief psychological intervention for PND.

METHODS

A literature review focused on various aspects of PND was conducted to develop a model of care and intervention under NMHP. A panel of national and international experts and stakeholders reviewed the literature, opinions, perspectives, and proposal for different models and interventions, using a consensus method and WHO implementation toolkit.

RESULTS

A consensus was reached to develop an ANM (Auxillary nurse midwife)-based stepped-care model consisting of the components of care, training, and referral services for PND. Furthermore, a brief psychological intervention (BIND-P) was developed, which includes the components of the low-intensity intervention (eg, exercise, sleep hygiene).

CONCLUSION

The BIND-P model and intervention provide a practical approach that may facilitate effective identification, treatment, and support women with PND. We are currently evaluating this model across four study sites in India, which may help in the early detection and provision of appropriate and integrative care for PND.

Prevalence of Hypothyroidism in Pregnant Women in India: A Meta-Analysis of Observational Studies

INTRODUCTION

This meta-analysis was conducted to estimate the prevalence of hypothyroidism among pregnant women in India.

METHODS

We searched PubMed, Web of Science, Scopus, Google Scholar, and Shodhganga (Indian thesis repository) for observational studies, providing prevalence of hypothyroidism among pregnant women in India. Systematic study selection and data extraction procedures were followed. Quality assessment of each study was done using JBI critical appraisal checklist. The random effects model was used for pooling the effect sizes. Publication bias was assessed using the funnel plot and rank correlation test. I 2 statistics was used to measure heterogeneity across the studies. Heterogeneity in the pooled estimates was further explored with subgroup analyses and meta-regression analysis.

RESULTS

Sixty-one studies were found eligible and included in this review. The pooled estimate of the prevalence of hypothyroidism in pregnant women was 11.07% (95% CI: 8.79-13.84, I 2 = 99%). Pooled prevalence estimates of subclinical and overt hypothyroidism are 9.51% (95% CI: 7.48-12.04, I 2 = 98%) and 2.74% (95% CI: 2.08-3.58, I 2 = 94%).

CONCLUSION

We documented 11.07% pooled prevalence of hypothyroidism in pregnant women in India.

Association of thyroid antibodies status on the outcomes of pregnant women with hypothyroidism (maternal hypothyroidism on pregnancy outcomes, MHPO-4)

BACKGROUND

Autoimmunity increases with age and is often commonly evaluated in women of the reproductive age group. Prevalence of thyroid antibodies is common even in euthyroid pregnant women. We aim to compare the association of thyroid antibody status on the maternal and neonatal outcomes in pregnant women with hypothyroidism.

METHODS

We conducted a cross-sectional retrospective study on 718 cases in the Aga Khan University Hospital. Information was collected on pregnant women who have been diagnosed with hypothyroidism before conception or during their antenatal period. Laboratory data were recorded for thyroid peroxidase antibodies, anti-thyroglobulin antibodies, and thyroid-stimulating hormone levels. Maternal and neonatal outcomes were also noted from medical file records. Data analysis was performed on Statistical Package for the Social Sciences version 20.0.

RESULTS

Overall, 146 out 718 cases were included for final analysis. Thyroid peroxidase antibodies were positive in 66.4% and anti-thyroglobulin was positive in 52.1% cases, whereas 43.8% of cases had both antibodies positive. Pre-gestational diabetes was significantly associated with thyroid autoimmunity. There was a 73% less chance of gestational hypertension for thyroid autoimmune groups. Gestational diabetes and maternal (chronic) hypertension were found to have an independent effect on postpartum hemorrhage. Hypertensive disorders in pregnancy were found to have an independent risk for premature birth.

CONCLUSION

Our study reports a 74.7% prevalence of positive thyroid antibodies in hypothyroid pregnant women, with higher association with pre-gestational diabetes. Gestational hypertension was least likely to occur in thyroid autoimmune groups. None of the outcomes were independently associated with worse outcomes.

Neurological manifestation in severe hypothyroidism in pregnancy

Neurological manifestations of hypothyroidism include peripheral neuropathy and pituitary hyperplasia. However, these associations are rarely encountered during pregnancy. We report a case of a known hypothyroid with very high thyroid stimulating hormone (TSH) values (512 μIU/mL) in the second trimester. At 24 weeks she developed facial palsy and pituitary hyperplasia which responded to a combination of steroids and thyroxine. She had caesarean delivery at 35 weeks and 3 days gestation in view of pre-eclampsia with severe features and was discharged on oral antihypertensives and thyroxine. On follow-up at 5 months, TSH normalised and pituitary hyperplasia showed a greater than 50% reduction in size. To our knowledge, this is the first reported case of facial palsy and pituitary hyperplasia associated with hypothyroidism during pregnancy.

Estimation of Thyroid-Stimulating Hormone Level in Normal College Female Students in a Semi-Urban Indian Town: Kumbakonam Urban-Rural Epidemiological Study- KURES - 7

Background:

Subclinical hypothyroidism (SCH) is a biochemical disease which is characterized by elevated serum levels of thyroid stimulating hormone (TSH) with normal thyroid hormone levels. In an attempt to correct the disease at its entry point, we wished to find out the incidence of subclinical hypothyroidism in female college students in Kumbakonam, a semiurban town of India.

Methods:

Around 260 female college students who had no history of thyroid disease were screened for thyroid dysfunction by a TSH assay.

Results:

The mean age ± standard deviation was 18.72 ± 2.27 years. The mean TSH value was 3.98 mIU/mL. The incidence of abnormally high TSH values was around 11.5%. The number of such cases was 30 with low T3 values in six students. One had a value of 150 with no symptoms. Another student had a value of 0.15 and her T3-T4 profile was normal. All students were asymptomatic. None of the students had goiter.

Conclusions:

In an unpublished but accepted study, we found an incidence of 3.5% in the school female children in the age group of 15–17. A sudden jump in the incidence is occurring in the age group of 18–22. This needs a workup of the causative factors and their possible correction.

Cluster Analysis: A New Approach for Identification of Underlying Risk Factors and Demographic Features of First Trimester Pregnancy Women

Thyroid pathology is reported internationally in 5-10% of all pregnancies. The overall aim of this research was to determine the prevalence of hypothyroidism and risk factors during the first trimester screening in a Mexican patients sample. We included the records of 306 patients who attended a prenatal control consultation between January 2016 and December 2017 at the Women's Institute in Monterrey, Mexico. The studied sample had homogeneous demographic characteristics in terms of age, weight, height, BMI (body mass index) and number of pregnancies. The presence of at least one of the risk factors for thyroid disease was observed in 39.2% of the sample. Two and three clusters were identified, in which patients varied considerably among risk factors, symptoms and pregnancy complications. Compared to Cluster 0, one or more symptoms or signs of hypothyroidism occurred, while Cluster 1 was characterized by healthier patients. When three clusters were used, Cluster 2 had a higher TSH (thyroid stimulating hormone) value and pregnancy complications. There were no significant differences in perinatal variables. In addition, high TSH levels in first trimester pregnancy are characterized by pregnancy complications and decreased newborn weight. Our findings underline the high degree of disease heterogeneity with existing pregnant hypothyroid patients and the need to improve the phenotyping of the syndrome in the Mexican population.

Pregnancy Outcomes among Obese Pregnant Women with Hypothyroidism: Medical Record Review of a Single Tertiary Center in Saudi Arabia

Background Thyroid disorder is common among pregnant women. Hashimoto thyroiditis is the most common etiology of hypothyroidism among pregnant women. Many studies showed that hypothyroidism during pregnancy has been associated with negative outcomes for the mother and for child as well including miscarriage, intrauterine growth retardation, preterm delivery and cognitive impairment in the offspring. Objectives To assess the adverse maternal and neonatal outcome among hypothyroidism obese pregnant women. Methods This is a retrospective study conducted among obese pregnant women diagnosed with hypothyroidism attending King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia between January 1, 2013, and December 31, 2018. For analysis, we used (1) descriptive statistics, (2) Chi-square test, Pearson correlation, independent t-test, and one-way ANOVA to test the difference in thyroid stimulating hormone (TSH) levels and adverse pregnancy outcomes. A p-value of <0.05 is used to calculate statistical significance. Results A total of 9095 pregnant women had delivered in the last five years, 65 of these pregnant women had been diagnosed with hypothyroidism and 57 were enrolled in our study. Out of 65, 44 (77.2%) were Saudi, and 13 (22.8%) non-Saudis. Mean age at the time of delivery was 32.9 ± 5.6 years, while BMI means were 35.7 ± 4.6. A total of 35 (61.4%) were from class 1, 14 (26.2%) were from class 2 and eight (12.3%) were from class 3. Out of 57, 16 (28.1%) developed undesired antepartum outcomes, while 14 (21.5%) had postpartum outcomes. Preterm labor, gestational diabetes mellitus, and urinary tract infections were significantly associated with abnormal TSH levels (P < 0.05). Conclusion As demonstrated earlier, hypothyroidism during pregnancy leads to unfavorable outcomes. Therefore, screening for thyroid function tests in prenatal and antenatal periods is vital to avoid potential adverse outcomes.

Maternal characteristics and outcomes affected by hypothyroidism during pregnancy (maternal hypothyroidism on pregnancy outcomes, MHPO-1)

BACKGROUND

Hypothyroidism in pregnancy is an arena of ongoing research, with international conflicts regarding screening, management, and outcomes. Various studies have described the outcomes depending on geographical and international diagnostic criteria. No study has been conducted in this regard from the region of Pakistan. Therefore, we aim to report the clinical features and maternal outcomes of hypothyroid pregnancies and compare the maternal outcomes between uncontrolled and controlled TSH levels in the preconception as well as the gestational period.

METHODS

We conducted a cross-sectional retrospective study on 718 cases in the Aga Khan University Hospital after ethical approval. We collected information on pregnant females who have diagnosed hypothyroidism before conception or during their antenatal period. We noted the maternal characteristics and maternal comorbidities. Laboratory data were recorded for thyroid stimulating hormone levels before conception and during gestation. We recorded maternal outcomes as pregnancy loss (including miscarriage, stillbirth/intrauterine death, medical termination of pregnancy and ectopic pregnancy), gestational hypertension, pre-eclampsia, postpartum hemorrhage, placental abruption, and modalities of delivery. Data analysis was performed on Statistical Package for the Social Sciences version 20.0.

RESULTS

Among 708 hypothyroid women 638 had live births. Postpartum hemorrhage was the most frequent maternal outcome (38.8%). The emergency cesarean section occurred in 23.4% of cases. We determined TSH levels in 53.2, 56.7, 61.7 and 66.6% of cases in preconception, 1st, 2nd, and 3rd trimester periods. A significant association existed between cesarean section and preconception thyrotropin levels > 2.5 mIU/L, whereas postpartum hemorrhage was significantly associated with thyrotropin levels > 2.5 mIU/L in the preconception and third trimester.

CONCLUSION

Successful live births in our patients were complicated by maternal postpartum hemorrhage and a frequent number of emergency cesarean section.

Effectiveness of a counselling intervention implemented in antenatal setting for pregnant women facing domestic violence: a pre-experimental study

OBJECTIVE

To assess the effectiveness of a counselling intervention in antenatal care settings for pregnant women who report domestic violence.

DESIGN

Pre-experimental study with pretest-posttest design.

SETTINGS

Two public hospitals in Mumbai, India.

SAMPLE

In all, 2778 pregnant women accessing antenatal care (ANC) in the hospitals from February to November 2016 were approached for study participation; 2515 women consented. These women were screened by trained counsellors for domestic violence during pregnancy (domestic violence during pregnancy). Domestic violence during pregnancy was reported by 16.2% (408) of women. Of these, 155 women sought counselling services. Post-intervention analyses were carried out with 142 women at 6 weeks post-delivery; 13 women were not contactable.

METHODS

The 442 women who reported domestic violence during pregnancy were provided a minimum of two counselling sessions by trained counsellors during their ANC visits. A counselling intake form was used to collect pre- and post-intervention data.

MAIN OUTCOME MEASURES

Prevalence of domestic violence during pregnancy, change in women's ability to cope, safety, and health.

RESULTS

Prevalence of domestic violence during pregnancy (16.1%) was comparable to those of common obstetric complications routinely screened for during ANC. In all, 60-65% women reported cognitive changes such as recognising impact of violence and need to speak out against it. In all, 50.7% women took action at the individual level to address domestic violence during pregnancy. This change was not statistically significant (P-value 0.193). Of the women studied, 35.9% adopted at least one safety measure, and 84% of the women reported better health status post-intervention.

CONCLUSIONS

Routine enquiry and counselling for domestic violence during pregnancy are effective in improving women's ability to cope, safety, and health.

FUNDING

This study was funded by The John D. and Catherine T. MacArthur Foundation.

TWEETABLE ABSTRACT

Improving coping strategies, safety and health of pregnant women who reported domestic violence by providing counselling in antenatal care setting.

Antepartum Risk Assessment for Pregnant Women Visiting a Tertiary Care University Teaching Hospital in Southern India

AIM

The study was conducted to assess the prevalence of high-risk pregnancy (HRP) cases among pregnant women visiting the Prabhakar Kore Hospital (PKH) at Belagavi, Karnataka for antenatal care (ANC) and determination of the level of risk in the identified cases.

MATERIALS & METHODS

Data were collected as a part of a screening procedure of a nutrition supplement clinical trial on pregnant women [Study title: Maternal DHA Supplementation and offspring Neurodevelopment in India (DHANI)]. ANC case records including detailed notes on medical and obstetric history, physical examination, laboratory investigations of pregnant women with ≤ 20 weeks of gestational age were screened for known risk factors.

RESULTS

A total of 11,686 new cases were registered for ANC between June 2016 through August 2017. Of these, 3379 (<20 weeks gestation) were screened out of 428 pregnant women, 12.6% pregnant women were found to be at risk, 40.2% (n=172) fell in the high-risk category. Most commonly reported risk factors were thyroid disorders (27.3%, hypothyroidism 17.3%; hyperthyroidism 10%), gestational diabetes (16.1%), bad obstetric history (12.6%) and anaemia (10.7%).

CONCLUSION

Early identification of these at-risk mothers through a simple, practical, reliable and customized risk scoring schedule can ensure interventions either to control the risk causing factor or delivery of timely and appropriate care as and when needed.

CLINICAL SIGNIFICANCE

Considering the disproportionate burden that high risk pregnancies pose on higher mortality rates and compromised quality of life for the cases which survive, early identification of these high risk cases (12.6% identified in this study) can have a significant impact on maternal and child health. The population negatively affected by at-risk pregnancies is only expected to increase in the near future in light of the rising trend of its known risk factors such as high blood pressure, diabetes, or being HIV-positive.

Prevalence of subclinical hypothyroidism in pregnancy in Saudi Arabia

objectives:

To estimate the prevalence of subclinical hypothyroidism (SCH) in Saudi Arabia and assess the need for an SCH screening program.

Methods:

This cross-sectional study was conducted at King Abdulaziz Medical City and the Khashmulaan Clinic at the National Guard Health Affairs, Riyadh, Saudi Arabia in August 2016. All women attending the antenatal clinics were invited to participate in the study. In addition, data were retrieved from the files of pregnant women who had been screened for hypothyroidism from January 2016 to August 2016. A total of 384 pregnant women were included in the study.

Results:

The prevalence of SCH in pregnant women in this study was 50/384 (13%) with 95% confidence intervals (CIs): 9.82%-16.80%. Pregnant women who were randomly screened using a survey (n=127) were 3 times more likely (OR: 3.1; 95% CI: 1.182 to 8.704, p=0.022) to have SCH compared to pregnant women who were screened based on their physician’s judgement (n=257). Results showed older age (≥40 years) was associated with an insignificant decrease in the risk of SCH.

Conclusion:

Random screening for SCH in pregnant women showed a higher prevalence in comparison to women who were screened as a result of physician referrals. The results highlight the urgent need for larger studies to investigate the prevalence of SCH as well as the need for an SCH screening program.

Study on Coagulation Factor VIII and Fibrinogen Levels in Patients with Thyroid Disorders

INTRODUCTION

A kaleidoscope of coagulation disorders has been reported in patients with thyroid dysfunctions. Globally, these disorders involve both primary and secondary hemostasis and range from subclinical laboratory abnormalities to, more rarely, life-threatening hemorrhages or thrombotic events. While overt hypothyroidism appears to be associated with a bleeding tendency, hyperthyroidism emerged to have an increased risk of thrombotic events. As a controversy, subclinical hypothyroidism and mild hypothyroidism have been reported as prothrombotic state. The mechanisms involved in these observations are also not conformed.

OBJECTIVE

To study the levels of prothrombotic coagulation factor VIII and fibrinogen in patients with thyroid disorder at baseline and to correlate the change in these factors after attaining euthyroid state by treatment.

STUDY DESIGN

This was a longitudinal interventional study.

SUBJECTS AND METHODS

Forty patients were recruited based on the inclusion and exclusion criteria, and their coagulation profile (prothrombin time, aPTT, Factor VIII, and fibrinogen levels), routine hematological, and biochemical profile was done at baseline and 6 weeks after attaining euthyroid state.

RESULTS AND CONCLUSION

Hyperthyroidism and mild hypothyroidism were found to be hypercoagulable states and moderate-to-severe hypothyroidism as hypocoagulable states. Nevertheless, further observational and intervention studies are needed to provide more definitive information on the clinical relevance of this association, along with the potential implication for prevention and treatment of coagulation/fibrinolytic abnormalities in patients with thyroid dysfunction.

Prevalence of Hypothyroidism in Term Pregnancies in North India

BACKGROUND

Hypothyroidism is common in pregnancy. No study has determined the prevalence of hypothyroidism in term pregnancies in India.

AIM

This study aims to determine the prevalence and correlates of hypothyroidism in women who delivered at a center in Karnal, Haryana, North India.

RESULTS

Indoor records of all women who had delivered at this centre from April 2016 to March 2017 were reviewed. The prevalence of hypothyroidism was 12.3%, of which 15.5% were diagnosed during pregnancy. The dose requirement of L-thyroxine ranged from 25 to 200 μg (mean 76.38 +- 43.02). With this, 80% were able to achieve trimester-specific thyroid-stimulating hormone targets. Hypothyroidism did not correlate with any medical or obstetric complications.

CONCLUSION

Hypothyroidism is common in term pregnancies. If treated adequately, healthy fetomaternal outcomes can be achieved.