Lauren E Johns1, Kelly K Ferguson1,2, David E Cantonwine3, Bhramar Mukherjee4, John D Meeker1, Thomas F McElrath3. 1. Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan. 2. Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina. 3. Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 4. Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.
Abstract
Context: Overt thyroid disease in pregnancy is a known risk factor for abnormal fetal growth and development. Data on the effects of milder forms of variation in maternal thyroid function on intrauterine growth are less well examined. Objective: We explored these associations using repeated thyroid hormone and ultrasound measurements. Design, Setting, and Participants: Data were obtained from 439 pregnant women without diagnosed thyroid disease who were participants in a case-control study of preterm birth nested within an ongoing prospective birth cohort in Boston, Massachusetts. Main Outcome Measures: Ultrasound and delivery indices of fetal growth were standardized to those measured in a larger population. Results: At median 10, 18, and 26 weeks of gestation, we observed significant inverse associations between free thyroxine (FT4) and birth weight z scores, with the strongest association detected at median 10 weeks, at which time a 10% increase in FT4 was associated with a 0.02 z score decrease (∼8.5 g) in birth weight (β = -0.41 for ln-transformed FT4; 95% confidence interval, -0.64 to -0.18). FT4 was also inversely associated with repeated measurements of estimated fetal weight, head circumference, and abdominal circumference. We observed weaker inverse associations for total T4 and a positive relationship between total triiodothyronine and birth weight z scores. We did not observe any associations for thyroid-stimulating hormone. Conclusion: In pregnant women without overt thyroid disease, subclinical changes in thyroid function parameters may influence fetal growth.
Context: Overt thyroid disease in pregnancy is a known risk factor for abnormal fetal growth and development. Data on the effects of milder forms of variation in maternal thyroid function on intrauterine growth are less well examined. Objective: We explored these associations using repeated thyroid hormone and ultrasound measurements. Design, Setting, and Participants: Data were obtained from 439 pregnant women without diagnosed thyroid disease who were participants in a case-control study of preterm birth nested within an ongoing prospective birth cohort in Boston, Massachusetts. Main Outcome Measures: Ultrasound and delivery indices of fetal growth were standardized to those measured in a larger population. Results: At median 10, 18, and 26 weeks of gestation, we observed significant inverse associations between free thyroxine (FT4) and birth weight z scores, with the strongest association detected at median 10 weeks, at which time a 10% increase in FT4 was associated with a 0.02 z score decrease (∼8.5 g) in birth weight (β = -0.41 for ln-transformed FT4; 95% confidence interval, -0.64 to -0.18). FT4 was also inversely associated with repeated measurements of estimated fetal weight, head circumference, and abdominal circumference. We observed weaker inverse associations for total T4 and a positive relationship between total triiodothyronine and birth weight z scores. We did not observe any associations for thyroid-stimulating hormone. Conclusion: In pregnant women without overt thyroid disease, subclinical changes in thyroid function parameters may influence fetal growth.
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