CORRELATION BETWEEN ТHYROID STIMULATING HORMONE (TSH) LEVELS IN MATERNAL BLOOD AND RISK OF SPONTANEOUS ABORTION IN THE FIRST TRIMESTER
Keywords:
thyroid stimulating hormone (TSH), spontaneous abortion, thyroid dysfunctionAbstract
Thyroid dysfunction is common among women between the ages of 20 and 45, and thus a more common etiology for spontaneous abortion in the first trimester of pregnancy. The prevalence of thyroid disorders in this group of patients is between 5 and 7% for subclinical hypothyroidism, 2 4.5% for hypothyroidism, 0.5 1% for hyperthyroidism and 5 10% for autoimmune thyroiditis/thyroid autoimmunity. Every normal pregnancy is followed by changes in the physiology of the thyroid gland, which are also reflected by changes in the thyroid function tests. Physiological adaptation is necessary so that the pregnant woman's body can respond to the increased metabolic needs during pregnancy. Diseases of the thyroid gland reduce its ability to adapt and respond to the new needs of pregnancy and this can result in a poor pregnancy outcome and, in most cases, spontaneous abortion.
Objective: The objective of this paper is to determine the relationship between the level of thyroid stimulating hormone (TSH) in the first trimester of pregnancy and the occurrence of spontaneous abortion.
Methods: Serum thyroid stimulating hormone (TSH), free and total thyroxine (fT4 and tT4) and antithyroid peroxidase antibodies (antiTPO Ab) were determined in 52 pregnant women in the first trimester of pregnancy. Women were divided into groups according to the level of TSH and the presence of antiTPO Ab, according to the latest recommendations of the American Thyroid Association (ATA) and according to the local reference values for TSH. The risk of spontaneous abortion in the first trimester was calculated for each group as well as the correlation with other parameters: age of the patients, week of occurrence of spontaneous abortion, history of previous spontaneous abortions and number of pregnancies.
Results: Spontaneous abortion in the first trimester of pregnancy was detected in 38.5% (n=20) of the examined cases. Using the Chi Square test, a cut off value of 2.00 mIU/L for TSH levels was found to be a significant value in relation to the number of spontaneous abortions (p=0.005). Patients with spontaneous abortion in the first trimester with TSH value > 2.0 mIU/L were 65% of all. Patients with positive antiTPO Ab were 22%, and in 16% of the patients with spontaneous abortion antiTPO Ab were with a value above the upper reference value.
Conclusion: In our study, results suggest a redefinition of the upper limit of reference values of TSH in the first trimester of pregnancy in addition to its reduction. History of previous abortion and age over 30 years were found to be significant predictive factors.
References
Abalovich, M., Gutierrez, S., Alcaraz, G., Maccallini, G., Garcia, A., & Levalle, O. (2002). Overt and subclinical hypothyroidism complicating pregnancy. Thyroid: Official Journal of the American Thyroid Association, 12(1), 63–68. https://doi.org/10.1089/105072502753451986
Adoueni, V. K., Azoh, A. J.-C., Kouame, E., Meless, D. G., Sibailly, P., Derbe, A. K., N Guessan, M.-C., Dzade, K. B., Koffi, S., Kouakou, T., Arra, L. V., & Ouattara, Y. (2022). Prevalence and correlates of hypothyroidism in pregnancy: a cross-sectional study at Bouget General Hospital, Ivory Coast. The Pan African Medical Journal, 41, 37. https://doi.org/10.11604/pamj.2022.41.37.32553
Allan, W. C., Haddow, J. E., Palomaki, G. E., Williams, J. R., Mitchell, M. L., Hermos, R. J., Faix, J. D., & Klein, R. Z. (2000). Maternal thyroid deficiency and pregnancy complications: implications for population screening. Journal of Medical Screening, 7(3), 127–130. https://doi.org/10.1136/jms.7.3.127
Alexander, E. K., Pearce, E. N., Brent, G. A., Brown, R. S., Chen, H., Dosiou, C., Grobman, W. A., Laurberg, P., Lazarus, J. H., Mandel, S. J., Peeters, R. P., & Sullivan, S. (2017). 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid, 27(3), 315–389. https://doi.org/10.1089/thy.2016.0457
Ballabio, M., Poshyachinda, M., & Ekins, R. P. (1991). Pregnancy-Induced Changes in Thyroid Function: Role of Human Chorionic Gonadotropin as Putative Regulator of Maternal Thyroid*. The Journal of Clinical Endocrinology & Metabolism, 73(4), 824–831. https://doi.org/10.1210/jcem-73-4-824
Blazer, S. (2003). Maternal hypothyroidism may affect fetal growth and neonatal thyroid function. Obstetrics & Gynecology, 102(2), 232–241. https://doi.org/10.1016/s0029-7844(03)00513-1
Bohn, M. K., & Adeli, K. (2021). Physiological and metabolic adaptations in pregnancy: importance of trimester-specific reference intervals to investigate maternal health and complications. Critical Reviews in Clinical Laboratory Sciences, 1–17. https://doi.org/10.1080/10408363.2021.1978923
Casey, B. M., Dashe, J. S., Wells, C. E., McIntire, D. D., Leveno, K. J., & Cunningham, F. G. (2006). Subclinical Hyperthyroidism and Pregnancy Outcomes. Obstetrics & Gynecology, 107(2, Part 1), 337–341. https://doi.org/10.1097/01.aog.0000197991.64246.9a
De Groot, L., Abalovich, M., Alexander, E. K., Amino, N., Barbour, L., Cobin, R. H., Eastman, C. J., Lazarus, J. H., Luton, D., Mandel, S. J., Mestman, J., Rovet, J., & Sullivan, S. (2012). Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 97(8), 2543–2565. https://doi.org/10.1210/jc.2011-2803
Glinoer, D., Riahi, M., Grün, J. P., & Kinthaert, J. (1994). Risk of subclinical hypothyroidism in pregnant women with asymptomatic autoimmune thyroid disorders. The Journal of Clinical Endocrinology & Metabolism, 79(1), 197–204. https://doi.org/10.1210/jcem.79.1.8027226
Glinoer, D. (1997). The Regulation of Thyroid Function in Pregnancy: Pathways of Endocrine Adaptation from Physiology to Pathology. Endocrine Reviews, 18(3), 404–433. https://doi.org/10.1210/edrv.18.3.0300
Gupta, P., Jain, M., Verma, V., & Gupta, N. K. (2021). The Study of Prevalence and Pattern of Thyroid Disorder in Pregnant Women: A Prospective Study. Cureus. https://doi.org/10.7759/cureus.16457
Haddow, J., Knight, G., Palomaki, G., McClain, M., & Pulkkinen, A. (2004). The reference range and within-person variability of thyroid stimulating hormone during the first and second trimesters of pregnancy. Journal of Medical Screening, 11(4), 170–174. https://doi.org/10.1258/0969141042467340
Mahadik, K., Choudhary, P., & Roy, P. K. (2020). Study of thyroid function in pregnancy, its feto-maternal outcome; a prospective observational study. BMC Pregnancy and Childbirth, 20(1). https://doi.org/10.1186/s12884-020-03448-z
Moog, N. K., Entringer, S., Heim, C., Wadhwa, P. D., Kathmann, N., & Buss, C. (2017). Influence of maternal thyroid hormones during gestation on fetal brain development. Neuroscience, 342, 68–100. https://doi.org/10.1016/j.neuroscience.2015.09.070
Oktay Bulur, Zeliha Atak, Derun Taner Ertugrul, Esin Beyan, Emre Günakan, Serdar Karakaya, Kubilay Şahin, & Dal, K. (2019). Trimester-specific reference intervals of thyroid function tests in Turkish pregnants. Gynecological Endocrinology, 36(5), 413–416. https://doi.org/10.1080/09513590.2019.1666817
Rueda-Galvis, M. V., & Builes-Barrera, C. A. (2022). Thyroid physiology and hypothyroidism in pregnancy. A review. Medicina & Laboratorio, 26(1), 15–33. https://www.medigraphic.com/cgi-bin/new/resumenI.cgi?IDARTICULO=107315
Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., Nixon, A., Pearce, E. N., Soldin, O. P., Sullivan, S., & Wiersinga, W. (2011). Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. Thyroid, 21(10), 1081–1125. https://doi.org/10.1089/thy.2011.0087
Sletner, L., Jenum, A. K., Qvigstad, E., & Hammerstad, S. S. (2021). Thyroid function during pregnancy in a multiethnic population in Norway. Journal of the Endocrine Society. https://doi.org/10.1210/jendso/bvab078
Valdés, S., Maldonado-Araque, C., Lago-Sampedro, A., Lillo, J. A., García-Fuentes, E., Pérez-Valero, V., Gutiérrez-Repiso, C., Ocon-Sanchez, P., Goday, A., Urrutia, I., Peláez, L., Delgado, E., Bordiú, E., Castaño, L., Castell, C., Delgado, E., Menéndez, E., Franch, J., Gaztambide, S., . . . Rojo-Martínez, G. (2017). Population-Based National Prevalence of Thyroid Dysfunction in Spain and Associated Factors: Di@bet.es Study. Thyroid, 27(2), 156–166. https://doi.org/10.1089/thy.2016.0353
Yamazaki, K., Sato, K., Kazuo Shizume, Y Kanaji, Ito, Y. M., Obara, T., Nakagawa, T., Koizumi, T., & Nishimura, R. (1995). Potent thyrotropic activity of human chorionic gonadotropin variants in terms of 125I incorporation and de novo synthesized thyroid hormone release in human thyroid follicles. The Journal of Clinical Endocrinology and Metabolism, 80(2), 473–479. https://doi.org/10.1210/jcem.80.2.7852507
