Evaluation of thyroid function during pregnancy and effects of thyroid dysfunction on maternal and fetal outcome.

Abstract

Background: Thyroid disease is the second most common endocrine disease to affect women of reproductive age and thyroid physiology changes significantly during pregnancy.Thyroid dysfunction in pregnancy has adverse effects on maternal and fetal wellbeing.
Objectives: To evaluate thyroid function in pregnant females.
To study adverse effects of thyroid dysfuction on maternal and fetal outcome.
Participants: Pregnant patients at 10 weeks of gestation.
Study design: Prospective observational study.

Method: This was a prospective study done in pregnant women who attended the antenatal clinic at 10 weeks of gestation. A total of 600 patients were included, their TSH at 10 weeks of gestation was measured and they were followed throughout their pregnancy. Patients were categorized into two groups: Group A with TSH value of > 2.5mIU/L or < 0.1mIU/L and Group B with TSH value of 0.1 – 2.5mIU/L. Maternal outcome was measured in terms of abortions, pre eclampsia, preterm delivery, gestational diabetes mellitus, intrauterine growth restriction, stillbirths, placental abruption and postpartum heamorrhage. Fetal outcome was measured in terms of Apgar score at 1 minute and 5 minutes of life, congenital malformations, birth weight, neonatal TSH at 4 days of life.
Results: The incidence of abortions, pre eclampsia, preterm labour, intrauterine growth retardation, placental abruption, low Apgar score at 1 minute of life, low birth weight and neonatal hypothyroidism was significantly high in Group A as compared to Group B. However the difference in the incidence of gestational diabetes mellitus, still births, postpartum heamorrhage, congenital malformations and Apgar score at 5 minutes of life was not statistically significant.
Conclusion: High TSH values can significantly add to the maternal and neonatal morbidity, but early initiation and maintenance of a normal level of thyroid hormones significantly minimizes the risk of maternal and fetal complications.
Implications: Normal level of thyroid hormones significantly minimizes the risk of maternal and fetal complications.