| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Department of Endocrinology (R.N., G.F.), Azienda Ospedaliera LE/1, 73100 Lecce, Italy; Department of Obstetrics and Gynecology (T.M.), Casa di Cura "Salus", 72100 Brindisi, Italy; Department of Internal Medicine (A.P., D.D.), Azienda Ospedaliera PR, "Di Vaio" Hospital, 43036 Fidenza, Italy; and Endocrine Unit (H.H.), Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, Brunei Darussalam BA 1000
Address all correspondence and requests for reprints to: Roberto Negro, Department of Endocrinology, Azienda Ospedaliera LE/1, P.O. "V. Fazzi", Piazza F. Muratore, 73100 Lecce, Italy. E-mail: robnegro{at}tiscali.it.
Context: Euthyroid women with autoimmune thyroid disease show impairment of thyroid function during gestation and seem to suffer from a higher rate of obstetrical complications.
Objective: We sought to determine whether these women suffer from a higher rate of obstetrical complications and whether levothyroxine (LT4) treatment exerts beneficial effects.
Design: This was a prospective study.
Setting: The study was conducted in the Department of Obstetrics and Gynecology.
Patients: A total of 984 pregnant women were studied from November 2002 to October 2004; 11.7% were thyroid peroxidase antibody positive (TPOAb+).
Intervention: TPOAb+ patients were divided into two groups: group A (n = 57) was treated with LT4, and group B (n = 58) was not treated. The 869 TPOAb– patients (group C) served as a normal population control group.
Main Outcome Measures: Rates of obstetrical complications in treated and untreated groups were measured.
Results: At baseline, TPOAb+ had higher TSH compared with TPOAb–; TSH remained higher in group B compared with groups A and C throughout gestation. Free T4 values were lower in group B than groups A and C after 30 wk and after parturition. Groups A and C showed a similar miscarriage rate (3.5 and 2.4%, respectively), which was lower than group B (13.8%) [P < 0.05; relative risk (RR), 1.72; 95% confidence interval (CI), 1.13–2.25; and P < 0.01; RR = 4.95; 95% CI = 2.59–9.48, respectively]. Group B displayed a 22.4% rate of premature deliveries, which was higher than group A (7%) (P < 0.05; RR = 1.66; 95% CI = 1.18–2.34) and group C (8.2%) (P < 0.01; RR = 12.18; 95% CI = 7.93–18.7).
Conclusions: Euthyroid pregnant women who are positive for TPOAb develop impaired thyroid function, which is associated with an increased risk of miscarriage and premature deliveries. Substitutive treatment with LT4 is able to lower the chance of miscarriage and premature delivery.
This article has been cited by other articles:
 |
|
 |
|
  C. Dosiou, G. D Sanders, S. S Araki, and L. M Crapo Screening pregnant women for autoimmune thyroid disease: a cost-effectiveness analysis. Eur. J. Endocrinol., June 1, 2008; 158(6): 841 - 851. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Kitzmiller, J. M. Block, F. M. Brown, P. M. Catalano, D. L. Conway, D. R. Coustan, E. P. Gunderson, W. H. Herman, L. D. Hoffman, M. Inturrisi, et al. Managing Preexisting Diabetes for Pregnancy: Summary of evidence and consensus recommendations for care Diabetes Care, May 1, 2008; 31(5): 1060 - 1079. [Full Text] [PDF]
|
|
|
|
 |
|
 E. E. Wasserman, K. Nelson, N. R. Rose, W. Eaton, J. P. Pillion, E. Seaberg, M. V. Talor, L. Burek, A. Duggan, and R. H. Yolken Maternal Thyroid Autoantibodies during the Third Trimester and Hearing Deficits in Children: An Epidemiologic Assessment Am. J. Epidemiol., March 15, 2008; 167(6): 701 - 710. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Biondi and D. S. Cooper The Clinical Significance of Subclinical Thyroid Dysfunction Endocr. Rev., February 1, 2008; 29(1): 76 - 131. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Bellver, S. R. Soares, C. Alvarez, E. Munoz, A. Ramirez, C. Rubio, V. Serra, J. Remohi, and A. Pellicer The role of thrombophilia and thyroid autoimmunity in unexplained infertility, implantation failure and recurrent spontaneous abortion Hum. Reprod., February 1, 2008; 23(2): 278 - 284. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Schlechte Update in Endocrinology Ann Intern Med, October 16, 2007; 147(8): 563 - 572. [Full Text] [PDF]
|
|
|
|
|
|
R. Stricker, M Echenard, R Eberhart, M-C Chevailler, V Perez, F A Quinn, and R. Stricker Evaluation of maternal thyroid function during pregnancy: the importance of using gestational age-specific reference intervals Eur. J. Endocrinol., October 1, 2007; 157(4): 509 - 514. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Glinoer and M. Abalovich Unresolved questions in managing hypothyroidism during pregnancy BMJ, August 11, 2007; 335(7614): 300 - 302. [Full Text] [PDF]
|
|
|
|
 |
|
 Subsection Reports J. Clin. Endocrinol. Metab., August 1, 2007; 92(8_suppl): s8 - s47. [Full Text] [PDF]
|
|
|
|
|
|
M. Abalovich, N. Amino, L. A. Barbour, R. H. Cobin, L. J. De Groot, D. Glinoer, S. J. Mandel, and A. Stagnaro-Green Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., August 1, 2007; 92(8_suppl): s1 - s47. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. A. Brent Diagnosing Thyroid Dysfunction in Pregnant Women: Is Case Finding Enough? J. Clin. Endocrinol. Metab., January 1, 2007; 92(1): 39 - 41. [Full Text] [PDF]
|
|
|
|
|
|
D. Glinoer Miscarriage in women with positive anti-tpo antibodies: is thyroxine the answer? J. Clin. Endocrinol. Metab., July 1, 2006; 91(7): 2500 - 2502. [Full Text] [PDF]
|
|
Read all eLetters
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Endocrinology | Endocrine Reviews | J. Clin. End. & Metab. |
| Molecular Endocrinology | Recent Prog. Horm. Res. | All Endocrine Journals |
