Spyridoula Maraka1,2, Naykky M Singh Ospina1,2, Derek T O'Keeffe1,3, Rene Rodriguez-Gutierrez1,2,4, Ana E Espinosa De Ycaza1, Chung-Il Wi5, Young J Juhn5, Charles C Coddington6, Victor M Montori1,2, Marius N Stan1. 1. 1 Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic , Rochester, Minnesota. 2. 2 Knowledge and Evaluation Research Unit (KER-Endo), Mayo Clinic , Rochester, Minnesota. 3. 3 Division of Endocrinology, Department of Medicine, National University of Ireland , Galway, Ireland . 4. 4 Division of Endocrinology, Department of Internal Medicine, University Hospital "Dr. Jose E. Gonzalez," Autonomous University of Nuevo Leon , Monterrey, Mexico . 5. 5 Department of Pediatric and Adolescent Medicine, Mayo Clinic , Rochester, Minnesota. 6. 6 Department of Obstetrics and Gynecology, Mayo Clinic , Rochester, Minnesota.
Abstract
BACKGROUND: Subclinical hypothyroidism (SCH) has been associated with increased risk of adverse pregnancy outcomes in some, but not all, studies. Uncertainty remains regarding the impact of levothyroxine (LT4) therapy on improving health outcomes in pregnant women with SCH. The objective of this study was to assess the potential benefits of LT4 therapy in pregnant women with SCH. METHODS: The medical records were reviewed of pregnant women with SCH, defined as an elevated serum thyrotropin (TSH) of >2.5 mIU/L for the 1st trimester or >3 mIU/L for the 2nd and 3rd trimesters, but ≤10 mIU/L. Pregnant women were divided into two groups depending on whether they received LT4 (group A) or not (group B). Pregnancy loss and other pre-specified adverse outcomes were evaluated during follow-up. RESULTS: There were 82 women in group A and 284 in group B. Group A had a higher body mass index (p = 0.04) and a higher serum TSH level (p < 0.0001) compared with group B. Group A had fewer pregnancies lost (n = 5 [6.1%] vs. n = 25 [8.8%]; p = 0.12), low birth weight (LBW) offspring (1.3% vs. 10%; p < 0.001), and no neonates with a five-minute Apgar score ≤7 (0% vs. 7%; p < 0.001) compared with group B. Other pregnancy-related adverse outcomes were similar between the two groups. Inferences remained unchanged after considering different models to adjust for potential predictors of outcome. CONCLUSIONS: LT4 therapy is associated with a decreased risk of LBW and a low Apgar score among women with SCH. This association awaits confirmation in randomized trials before the widespread use of LT4 therapy in pregnant women with SCH.
BACKGROUND:Subclinical hypothyroidism (SCH) has been associated with increased risk of adverse pregnancy outcomes in some, but not all, studies. Uncertainty remains regarding the impact of levothyroxine (LT4) therapy on improving health outcomes in pregnant women with SCH. The objective of this study was to assess the potential benefits of LT4 therapy in pregnant women with SCH. METHODS: The medical records were reviewed of pregnant women with SCH, defined as an elevated serum thyrotropin (TSH) of >2.5 mIU/L for the 1st trimester or >3 mIU/L for the 2nd and 3rd trimesters, but ≤10 mIU/L. Pregnant women were divided into two groups depending on whether they received LT4 (group A) or not (group B). Pregnancy loss and other pre-specified adverse outcomes were evaluated during follow-up. RESULTS: There were 82 women in group A and 284 in group B. Group A had a higher body mass index (p = 0.04) and a higher serum TSH level (p < 0.0001) compared with group B. Group A had fewer pregnancies lost (n = 5 [6.1%] vs. n = 25 [8.8%]; p = 0.12), low birth weight (LBW) offspring (1.3% vs. 10%; p < 0.001), and no neonates with a five-minute Apgar score ≤7 (0% vs. 7%; p < 0.001) compared with group B. Other pregnancy-related adverse outcomes were similar between the two groups. Inferences remained unchanged after considering different models to adjust for potential predictors of outcome. CONCLUSIONS:LT4 therapy is associated with a decreased risk of LBW and a low Apgar score among women with SCH. This association awaits confirmation in randomized trials before the widespread use of LT4 therapy in pregnant women with SCH.
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Authors: Spyridoula Maraka; Raphael Mwangi; Rozalina G McCoy; Xiaoxi Yao; Lindsey R Sangaralingham; Naykky M Singh Ospina; Derek T O'Keeffe; Ana E Espinosa De Ycaza; Rene Rodriguez-Gutierrez; Charles C Coddington; Marius N Stan; Juan P Brito; Victor M Montori Journal: BMJ Date: 2017-01-25
Authors: Freddy J K Toloza; Sarah E Theriot; Naykky M Singh Ospina; Sameen Nooruddin; Brooke Keathley; Stacey M Johnson; Nalin Payakachat; Elena Ambrogini; Rene Rodriguez-Gutierrez; Derek T O'Keeffe; Juan P Brito; Victor M Montori; Nafisa K Dajani; Spyridoula Maraka Journal: Thyroid Date: 2021-01-19 Impact factor: 6.568