ECE2018 Guided Posters Thyroid non cancer - Autoimmune Thyroid disease/pregnancy (10 abstracts)
Impact of TSH during the first trimester of pregnancy in obstetric and fetal complications: Usefulness of 2.5 mIU/l cut-off value
Berta Soldevila 1, , Marta Hernández 4, , Carolina López 4, , Laura Cacenarro 1, , María Martínez-Barahona 7, , Elisabet Palomera 2, , Ferran Rius 4, , Albert Lecube 4, , María José Pelegay 9 , Jordi García 10 , Dídac Mauricio 1, & Manel Puig-Domingo 1,
1Endocrinology and Nutrition Department, Germans Trias i Pujol University Hospital, Badalona, Spain; 2Institute for Health Science Research Germans Trias i Pujol, Badalona, Spain; 3CiBER de diabetes y enfermedades metabólicas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain; 4Endocrinology and Nutrition Department, Arnau de Vilanova University Hospital, Lleida, Spain; 5Biomedical Research Institute of Lleida, Lleida, Spain; 6Endocrinology and Nutrition Department, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; 7Paedriatics Department, Universitary Germans Trias i Pujol Hospital, Badalona, Spain; 8Research Unit, Mataró Hospital, Mataró, Spain; 9Gynecology and Obstetrics Department, Arnau de Vilanova University Hospital, Lleida, Spain; 10Paedriatics Department, Arnau de Vilanova University Hospital, Lleida, Spain.
Background: An association of pregnancy outcomes with subclinical hypothyroidism have been reported, however, there still exists a strong controversy regarding whether subclinical hypothyroidism ought to be dealt with or not. The latest American Thyroid Association’s guideline gives support to a higher TSH upper reference range of 4 mIU/l than the one proposed a few years ago of 2.5 mIU/l for the first trimester of pregnancy, in the absence of local normal ranges of TSH. In spite of this, the controversy regarding the upper limit of TSH during pregnancy for the treatment of subclinical gestational hypothyroidism seems to be far from being clarified.
Objective: To evaluate the association of fetal-maternal complications with first trimester maternal TSH values.
Patients and methods: A retrospective study in a single tertiary care hospital was performed. Thyrotropin (TSH) universal screening was performed between weeks 9–12 of gestation in 1981 pregnant women during 2012. Outcomes included fetal-maternal complications and newborn health parameters.
Results: Median TSH was 1.72 (0.99–2.61) mIU/l. The incidence of perinatal loss, miscarriage and stillbirth was 7.2, 5.9 and 1.1% respectively. Median TSH of women with and without miscarriage was 1.97 (1.29–3.28) vs 1.71 (0.96–2.58) mIU/l (P=0.009). Incidence of preeclampsia was 3.2%; TSH in these women was 2.10 (1.40–2.74) vs 1.71 (0.98–2.59) mIU/l in those without (P=0.027). TSH in women with dystocia in labor was 1.76 (1.00–2.53) vs 1.68 (0.94–2.59) mIU/l and in those who gave birth with normal progression (P=0.044). Women with TSH 2.5–5.1 mIU/l had a higher risk of perinatal loss (OR 1.589 (1.085–2.329), P=0.017), miscarriage (OR 1.702 (1.126–2.572), P=0.012) and premature birth (OR 1.379 (1.013–1.876), P=0.041). There was no association with the other outcomes analyzed. A composite variable was constructed including fetal-maternal complications and newborn health parameters in order to assess which TSH value would predict an adverse outcome by using ROC curves. The area under the curve obtained was 0.528, not allowing the definition of a useful cut-off point predicting adverse outcomes.
Conclusions: Our data support that higher levels of TSH within the reference normal concentrations during the first trimester are associated with higher risk of adverse obstetric outcomes (perinatal loss, miscarriage and premature birth). In our study, there is not a useful crude TSH cut-off point predicting adverse outcomes.
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Endocrine Abstracts
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