Increased Pregnancy Loss Rate in Thyroid Antibody Negative Women with TSH Levels between 2.5 and 5.0 in the First Trimester of Pregnancy

Division of Endocrinology, V. Fazzi Hospital, 73100 Lecce, Italy. .
The Journal of Clinical Endocrinology and Metabolism (Impact Factor: 6.21). 09/2010; 95(9):E44-8. DOI: 10.1210/jc.2010-0340
Source: PubMed


The definition of what constitutes a normal TSH during pregnancy is in flux. Recent studies suggested that the first trimester upper limit of normal for TSH should be 2.5 mIU/liter.
The objective of the study was to evaluate the pregnancy loss and preterm delivery rate in first-trimester thyroid peroxidase antibody-negative women with TSH values between 2.5 and 5.0 mIU/liter.
The present study is a component of a recently published large-scale prospective trial that evaluated the impact of levothyroxine treatment on maternal and neonatal complications in thyroid peroxidase-positive women with TSH levels above 2.5 mIU/liter. The present study evaluated 4123 thyroid peroxidase antibody-negative women with TSH levels at or below 5.0 mIU/liter. Women were divided into two groups based on their initial TSH: group A, TSH level below 2.5 mIU/liter, excluding hyperthyroid women defined as an undetectable TSH with an elevated free T(4), and group B, TSH level between 2.5 and 5.0 mIU/liter.
The study was conducted at two ambulatory clinics of community hospitals in southern Italy.
A total of 4123 women were evaluated.
There was no intervention.
The incidence of pregnancy loss and preterm delivery in group A as compared with group B was measured.
The rate of pregnancy loss was significantly higher in group B as compared with group A (6.1 vs. 3.6% respectively, P = 0.006). There was no difference in the rate of preterm delivery between the two groups.
The increased incidence of pregnancy loss in pregnant women with TSH levels between 2.5 and 5.0 mIU/liter provides strong physiological evidence to support redefining the TSH upper limit of normal in the first trimester to 2.5 mIU/liter.

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    • "Moreover, the relationship between thyroid dysfunction and negative outcomes for the mother in terms of miscarriage, preterm delivery and preeclampsia as well as for child in terms of decreased intelligence quotient and birth weight is relatively well known [15,16]. Even subclinical hypothyroidism without thyroid autoantibodies seems to be associated with the above mentioned problems [16-19]. Treatment of overt hypothyroidism during pregnancy is, therefore, mandatory and consists of levothyroxine therapy adjusted to achieve normal trimester-specific serum levels of thyroid stimulating hormone (TSH). "
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    Reproductive Biology and Endocrinology 04/2014; 12(1):28. DOI:10.1186/1477-7827-12-28 · 2.23 Impact Factor
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    • "Both maternal hypothyroidism and hyperthyroidism have been associated with a range of malplacentation disorders such as miscarriage, stillbirth , prematurity, pre-eclampsia and fetal growth restriction (Krassas et al., 2010), leading to increased perinatal morbidity and mortality. Even minor perturbations in maternal thyroid activity have been linked to miscarriage (Negro et al., 2010), preterm delivery and placental abruption (Casey et al., 2005). Increasing delay in achieving euthyroidism in pregnancies complicated by maternal thyroid dysfunction has been correlated with greater obstetric risks (Abalovich et al., 2002; LaFranchi et al., 2005), suggesting that key thyroid-responsive events during fetoplacental development are gestational age-dependent and may not be corrected at a later stage of pregnancy. "
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    • "Th ere are many studies with confl icting results in the literature about the possible association of hypothyroidism and positive thyroid autoantibodies as a risk factor for infertility and 1st trimester miscarriage (Abalovich et al. 2002; Negro et al. 2010; "
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    Journal of Obstetrics and Gynaecology 11/2013; 33(8):862-4. DOI:10.3109/01443615.2013.817983 · 0.55 Impact Factor
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