Association of Hypothyroidism and Anti-Thyroid Antibodies With Preterm Delivery: A Cross Sectional Study
AbstractObjective: Preterm delivery is a common and eventful phenomenon with long standing complications, heavily burdening the health system. Many risk factors have been suggested to increase the likelihood of this event, one being hypothyroidism and high levels of anti-thyroid antibodies. The present study sought to explore the association between hypothyroidism and anti-thyroid antibodies with preterm delivery.Materials and methods: A case control study was conducted on 400 patients attending Educational-Medical centers of Urmia University of Medical Sciences (Urmia, Iran) between November 2013 and April 2016, in which 200 patients with term deliveries and 200 patients with preterm deliveries were compared for differences in hypothyroidism, existence of anti- thyroperoxidase (TPO) antibodies based on blood samples obtained from the patients which were tested using chemi-luminescence method.Results: In the group of patients with preterm delivery, 85 patients had hypothyroidism (42.5%), and from the term delivery group, 67 patients (33.5%) had hypothyroidism, the difference was not statistically significant (p = 0.14). But, when groups of early and late preterm deliveries were compared in terms of having anti-TPO antibodies, there was a significant difference between them, with early preterm delivery having 8 patients positive out of 44 patients and late preterm delivery having 7 positives out of 141 patients (p = 0.004).Conclusion: Hypothyroidism had an insignificant effect on preterm delivery rates, but the existence of anti–TPO antibodies in the serum had a significant increasing effect on early preterm deliveries and could be regarded as a risk factor.
Cunningham FG LK, Bloom SL, Spong CY, Hoffman BL. Williams Obstetrics. 24th edition ed. New York: Mc Graw –Hill, 2014.
van den Broek NR, Jean-Baptiste R, Neilson JP. Factors associated with preterm, early preterm and late preterm birth in Malawi. PloS ONE 2014;9:e90128.
Fraser J, Walls M, McGuire W. Respiratory complications of preterm birth. Bmj 2004;329:962-5.
Ward RM, Beachy JC. Neonatal complications following preterm birth. BJOG 2003;110 Suppl 20:8-16.
Nosarti C, Reichenberg A, Murray RM, Cnattingius S, Lambe MP, Yin L, et al. Preterm birth and psychiatric disorders in young adult life. Arch Gen Psychiatry 2012;69:610-7.
Vikse BE, Irgens LM, Leivestad T, Hallan S, Iversen BM. Low birth weight increases risk for end-stage renal disease. J Am Soc Nephrol 2008;19:151-7.
Willemsen RH, de Kort SW, van der Kaay DC,
Hokken-Koelega AC. Independent effects of prematurity on metabolic and cardiovascular risk factors in short small-for-gestational-age children. J Clin Endocrinol Metab 2008;93:452-8.
Covarrubias L, Aguirre G, Chapuz J, May A, Velázquez J, Eguiluz M. [Maternal factors associated to prematurity]. Ginecol Obstet Mex 2008;76:526-36.
O'shea T, Allred E, Dammann O, Hirtz D, Kuban K, Paneth N, et al. The ELGAN study of the brain and related disorders in extremely low gestational age newborns. EARLY HUM DEV 2009;85:719-25.
Menon R. Spontaneous preterm birth, a clinical dilemma: etiologic, pathophysiologic and genetic heterogeneities and racial disparity. Acta Obstet Gynecol Scand 2008;87:590-600.
Burrow GN, Fisher DA, Larsen PR. Maternal and fetal thyroid function. N Engl J Med 1994;331:1072-8.
Malek A, Sager R, Kuhn P, Nicolaides KH, Schneider H. Evolution of maternofetal transport of immunoglobulins during human pregnancy. Am J Reprod Immunol 1996;36:248-55.
Männistö T, Mendola P, Grewal J, Xie Y, Chen Z, Laughon SK. Thyroid diseases and adverse pregnancy outcomes in a contemporary US cohort. J Clin Endocrinol Metab 2013;98:2725-33.
Korevaar TI, Schalekamp-Timmermans S, de Rijke YB, Visser WE, Visser W, de Muinck Keizer-Schrama SM, et al. Hypothyroxinemia and TPO-antibody positivity are risk factors for premature delivery: the generation R study. J Clin Endocrinol Metab 2013;98(:4382-90.
Negro R, Schwartz A, Stagnaro-Green A. Impact of Levothyroxine in Miscarriage and Preterm Delivery Rates in First Trimester Thyroid Antibody-Positive Women With TSH Less Than 2.5 mIU/L. J Clin Endocrinol Metab 2016;101:3685-90.
Saki F, Dabbaghmanesh MH, Ghaemi SZ, Forouhari S, Omrani GR, Bakhshayeshkaram M. Thyroid function in pregnancy and its influences on maternal and fetal outcomes. Int J Endocrinol Metab 2014;12: e19378.
Haddow JE, Cleary-Goldman J, McClain MR, Palomaki GE, Neveux LM, Lambert-Messerlian G, et al. Thyroperoxidase and thyroglobulin antibodies in early pregnancy and preterm delivery. Obstet Gynecol 2010;116:58-62.
Soto-Rivera CL, Fichorova RN, Allred EN, Van Marter LJ, Shah B, Martin CR, et al. The relationship between TSH and systemic inflammation in extremely preterm newborns. Endocrine 2015;48:595-602.
Stockigt JR, Lim C-F. Medications that distort in vitro
tests of thyroid function, with particular reference to estimates of serum free thyroxine. Best Pract Res Clin Endocrinol 2009;23:753-67.
Bhattacharyya R, Mukherjee K, Das A, Biswas MR, Basunia SR, Mukherjee A. Anti-thyroid peroxidase antibody positivity during early pregnancy is associated with pregnancy complications and maternal morbidity in later life. J Nat Sci Biol Med 2015;6:402-5.
Stagnaro-Green A, Chen X, Bogden JD, Davies TF, Scholl TO. The thyroid and pregnancy: a novel risk factor for very preterm delivery. Thyroid 2005;15:351-7.
Van Wassenaer AG, Kok JH, Dekker FW, De Vijlder JJ. Thyroid function in very preterm infants: influences of gestational age and disease. Pediatr Res 1997;42:604-9.
Tierney K, Delpachitra P, Grossmann M, Onwude J, Sikaris K, Wallace EM, et al. Thyroid function and autoantibody status among women who spontaneously deliver under 35 weeks of gestation. Clin Endocrinol (OXF) 2009;71:892-5.
He X, Wang P, Wang Z, He X, Xu D, Wang B. Thyroid antibodies and risk of preterm delivery: a meta-analysis of prospective cohort studies. Eur J Endocrinol 2012;167:455-64.
Vissenberg R, van Dijk MM, Fliers E, van der Post JA, van Wely M, Bloemenkamp KW, et al. Effect of levothyroxine on live birth rate in euthyroid women with recurrent miscarriage and TPO antibodies (T4-LIFE study). Contemp Clin Trials. 2015; 44:134-8.