Thyroid function test abnormalities tied to preterm birth

  • Korevaar TIM & al.
  • JAMA
  • 20 Aug 2019

  • International Clinical Digest
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Takeaway

  • Subclinical hypothyroidism, high maternal thyrotropin, isolated hypothyroxinemia, and thyroid peroxidase (TPO) antibody positivity in pregnancy are associated with increased risk for preterm birth, according to a systematic review and meta-analysis.

Why this matters

  • This study suggests that thyroid screening during pregnancy may be beneficial.

Key results

  • 3.1% of women had subclinical hypothyroidism (increased thyrotropin concentration with normal free thyroxine), 2.2% had isolated hypothyroxinemia (decreased free thyroxine with normal thyrotropin concentration), and 7.5% were TPO antibody positive.
  • 5.0% of women experienced preterm birth (gestational age
  • 0.7% had very preterm birth (gestational age
  • Risk for preterm birth was higher for women with:
    • Subclinical hypothyroidism (6.1% vs euthyroid, 5.0%; OR, 1.29; 95% CI, 1.01-1.64).
    • Isolated hypothyroxinemia (7.1% vs 5.0%; OR, 1.46; 95% CI, 1.12-1.90).
    • High maternal thyrotropin concentration (OR, 1.04; 95% CI, 1.00-1.09 per standard deviation).
    • TPO antibody positivity (6.6% vs 4.9% for negativity; OR, 1.33; 95% CI, 1.15-1.56).
  • High TPO antibody was associated with increased risk for very preterm birth (1.7% vs 0.7%; OR, 2.45; 95% CI, 1.81-3.32).
  • Study design

    • 19 cohorts including 47,045 pregnant women were subjected to meta-analysis.
    • Funding: Netherlands Organization for Scientific Research.

    Limitations

    • Only observational studies were included.

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