Context: Knowledge is scarce concerning the significance of thyroid dysfunction/antibodies during pregnancy in regard to pregnancy complications/later maternal morbidity.
Objective: The aim of this ...study was to evaluate the association between maternal thyroid dysfunction/antibodies during pregnancy and pregnancy complications or later maternal hypertension, diabetes, and thyroid disease.
Design and Setting: We studied a prospective population-based cohort, Northern Finland Birth Cohort 1986 (NFBC 1986), with follow-up of 20 yr. Medication and hospital discharge records were used to assess maternal morbidity to hypertension, diabetes, and thyroid diseases.
Participants: The study consisted of mothers of NFBC 1986 with early pregnancy serum samples for thyroid function and antibody analyses (n = 5805). Mothers were grouped and compared according to these test results.
Main Outcome Measures: We focused on preeclampsia and gestational diabetes during index pregnancy, later maternal hypertension, diabetes, and thyroid disease morbidity and total mortality.
Results: Thyroid dysfunction and antibodies were not associated with pregnancy complications. Overt hypothyroidism was associated with subsequent maternal thyroid disease hazard ratio (HR) (95% confidence interval), 17.7 (7.8–40.6) and diabetes 6.0 (2.2–16.4). Subclinical hypothyroidism 3.3 (1.6–6.9), TPO-Ab-positivity 4.2 (2.3–7.4), and TG-Ab-positivity 3.3 (1.9–6.0) were also associated with later thyroid disease. No association was found between thyroid dysfunction/antibodies and hypertension or overall mortality.
Conclusions: Thyroid dysfunction and antibodies during pregnancy seem to predict later thyroid disease. Overt hypothyroidism poses risk of diabetes.
Thyroid dysfunction and antibodies during pregnancy seem to predict later maternal morbidity to thyroid diseases.
Maternal hypothyroidism has been associated with adverse pregnancy outcomes. A large nationwide register-based cohort with data on medication purchases was established to study the associations ...between maternal hypothyroidism, levothyroxine (LT4) use, and pregnancy and perinatal complications.
The data included all singleton births between 2004 and 2013 (N = 571,785) in Finland. Hypothyroid mothers (n = 16,364) were identified in the Finnish Medical Birth Register. Of these women, 95.8% used LT4 medication, and 37.5% had consistent LT4 use during pregnancy. Hypothyroid mothers were compared to mothers without thyroid disease (N = 550,860) using logistic regression. The main outcome measures were pregnancy and perinatal complications.
Maternal hypothyroidism was associated with several pregnancy and perinatal complications, including gestational diabetes mellitus (odds ratio OR = 1.19 confidence interval (CI) 1.13-1.25), gestational hypertension (OR = 1.20 CI 1.10-1.30), severe preeclampsia (OR = 1.38 CI 1.15-1.65), cesarean section (OR = 1.22 CI 1.17-1.27), preterm births (OR = 1.25 CI 1.16-1.34), large-for-gestational age newborns (OR = 1.30 CI 1.19-1.42), major congenital anomalies (OR = 1.14 CI 1.06-1.22), and neonatal intensive care unit admission (OR = 1.23 CI 1.17-1.29). However, among mothers with consistent LT4 purchases, only the associations between gestational diabetes mellitus (OR = 1.12 CI 1.03-1.22), cesarean section (OR = 1.13 CI 1.06-1.21), neonatal intensive care unit admission (OR = 1.09 CI 1.01-1.29), and large-for-gestational age newborns (OR = 1.26 CI 1.10-1.45) and maternal hypothyroidism remained.
Maternal hypothyroidism is associated with several pregnancy and perinatal complications, but consistent LT4 use may reduce many of the risks.
Preeclampsia, a new-onset hypertensive disorder of pregnancy, is associated with lifetime cardiovascular disease risk, but less is known about risk after other pregnancy-related hypertension.
The ...Northern Finland Birth Cohort 1966 included all expected births from 1 year (N=12 055 women). Blood pressure measurements and other prospective data were determined from prenatal care records and questionnaires for 10 314 women. Subsequent diagnoses were ascertained from Finnish registries (average follow-up, 39.4 years). Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) estimate risks in hypertensive women compared with normotensive women. Hypertension during pregnancy was associated with increased risk of subsequent cardiovascular disease and arterial hypertension. Women with chronic hypertension and superimposed preeclampsia/eclampsia had high risk for future diseases. Gestational hypertension was associated with increased risk of ischemic heart disease (HR, 1.44 95% CI, 1.24-1.68), myocardial infarcts (HR, 1.75 95% CI, 1.40-2.19), myocardial infarct death (HR, 3.00 95% CI, 1.98-4.55), heart failure (HR, 1.78 95% CI, 1.43-2.21), ischemic stroke (HR, 1.59 95% CI, 1.24-2.04), kidney disease (HR, 1.91 95% CI, 1.18-3.09), and diabetes mellitus (HR, 1.52 95% CI, 1.21-1.89). Isolated systolic hypertension was associated with increased risk of myocardial infarct death (HR, 2.15 95% CI, 1.35-3.41), heart failure (HR, 1.43 95% CI, 1.13-1.82), and diabetes mellitus (HR, 1.42 95% CI, 1.13-1.78), whereas isolated diastolic hypertension was associated with increased risk of ischemic heart disease (HR, 1.26 95% CI, 1.05-1.50). Results were similar in nonsmoking women aged <35 years with normal weight and no diabetes mellitus during pregnancy.
Elevated blood pressure during pregnancy, regardless of type and even without known risk factors, signals high risk of later cardiovascular disease, chronic kidney disease, and diabetes mellitus. Clinical monitoring, risk factor evaluation, and early intervention could benefit women with hypertension in pregnancy.
To assess the frequency and perinatal outcomes of gestational diabetes mellitus (GDM) defined by the criteria according to the International Association of Diabetes in Pregnancy Study Group (IADPSG) ...and the National Institute for Health and Care Excellence (NICE) diagnostic criteria for GDM.
A retrospective cohort study.
Six secondary and tertiary delivery hospitals in Finland in 2009.
Pregnant women (N = 4,033) and their offspring.
We used data on comprehensive screening of pregnant women with a 2-h 75-g oral glucose tolerance test (OGTT), performed between gestational weeks 24 and 40. OGTT glucose concentrations were used to identify women who fulfilled IADPSG and NICE criteria. While cut-offs according to Finnish national criteria partly overlapped with both criteria, a subgroup of IADPSG- or NICE-positive GDM women remained undiagnosed by Finnish criteria and hence non-treated. They were analysed as subgroups and compared to controls who were negative with all cut-offs.
GDM prevalence, birth weight SD score (BWSDS), large for gestational age (LGA) and caesarean section (CS) rates.
Among the 4,033 women screened for GDM, 1,249 (31.0%) and 529 (13.1%) had GDM according to the IADPSG and NICE criteria, respectively. The LGA rate was similar in both groups. Regardless of the diagnostic criteria, women with GDM had a higher risk of induced delivery and CSs than controls. In IADPSG-positive non-treated women, offspring's BWSDS and CS rate were higher than in controls.
GDM prevalence was 2.4-fold higher according to the IADPSG compared with the NICE criteria but the LGA rate did not differ. BWSDS and CS rate were increased already with mild untreated hyperglycaemia.
Air pollution has been linked to gestational diabetes mellitus (GDM) but no studies have evaluated impact of preconception and early pregnancy air pollution exposures on GDM risk.
Electronic medical ...records provided data on 219,952 singleton deliveries to mothers with (n=11,334) and without GDM (n=208,618). Average maternal exposures to particulate matter (PM) ≤ 2.5μm (PM2.5) and PM2.5 constituents, PM ≤ 10μm (PM10), nitrogen oxides (NOx), carbon monoxide, sulfur dioxide (SO2) and ozone (O3) were estimated for the 3-month preconception window, first trimester, and gestational weeks 1–24 based on modified Community Multiscale Air Quality models for delivery hospital referral regions. Binary regression models with robust standard errors estimated relative risks (RR) for GDM per interquartile range (IQR) increase in pollutant concentrations adjusted for study site, maternal age and race/ethnicity.
Preconception maternal exposure to NOX (RR=1.09, 95% CI: 1.04, 1.13) and SO2 (RR=1.05, 1.01, 1.09) were associated with increased risk of subsequent GDM and risk estimates remained elevated for first trimester exposure. Preconception O3 was associated with lower risk of subsequent GDM (RR=0.93, 0.90, 0.96) but risks increased later in pregnancy.
Maternal exposures to NOx and SO2 preconception and during the first few weeks of pregnancy were associated with increased GDM risk. O3 appeared to increase GDM risk in association with mid-pregnancy exposure but not in earlier time windows. These common exposures merit further investigation.
•Air pollution may be related to gestational diabetes (GDM).•No prior studies have examined preconception exposure.•Maternal exposure to NOx and SO2 before conception increased subsequent GDM risk.•NOx and SO2 exposure in the first seven weeks of pregnancy also increased GDM risk.•Early exposure to O3 reduced GDM risk but risk increased after 15 weeks gestation.
Objective
Maternal hyperthyroidism and antithyroid medications have been associated with adverse pregnancy and perinatal outcomes. This nationwide register‐based study investigated the association of ...maternal hyperthyroidism and antithyroid drug (ATD) use with pregnancy outcomes and included all singleton births in Finland between 2004 and 2013 (N = 571 785).
Design, patients and measurements
Hyperthyroid mothers were identified in the Medical Birth Register, and data on ATD use before and/or during pregnancy were collected from the Prescription Register. The odds ratios, with 95% confidence intervals, for adverse outcomes among hyperthyroid mothers and mothers without thyroid disease were compared using logistic regression.
Results
In total, 2144 (0.37%) of all the women had diagnoses of hyperthyroidism, and 580 (27%) of these women had used ATDs before and/or during pregnancy. Compared to the mothers without thyroid disease, maternal hyperthyroidism was associated with older age, multiparity, smoking, previous miscarriages, and overweight or obesity. The mothers diagnosed with hyperthyroidism also had increased odds of gestational hypertensive disorders, caesarean sections, placental abruptions, preterm births, small‐for‐gestational‐age newborns and neonatal intensive care unit treatment. The odds of pregnancy and/or perinatal complications were higher among those who had used ATDs (indicative of active disease), but those who had not received ATD treatment also had increased odds of such complications compared to the mothers without thyroid disease.
Conclusions
Women with active hyperthyroidism and those with histories of hyperthyroidism should be considered at risk of developing pregnancy and perinatal complications and should therefore be monitored during pregnancy.
Obstetric complications among US women with asthma Mendola, Pauline, PhD; Laughon, S. Katherine, MD, MS; Männistö, Tuija I., MD, PhD ...
American journal of obstetrics and gynecology,
02/2013, Letnik:
208, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Objective We sought to characterize complications of pregnancy, labor, and delivery associated with maternal asthma in a contemporary US cohort. Study Design We studied a retrospective cohort based ...on electronic medical record data from 223,512 singleton deliveries from 12 clinical centers across the United States from 2002 through 2008. Results Women with asthma had higher odds of preeclampsia (adjusted odds ratio aOR, 1.14; 95% confidence interval CI, 1.06−1.22), superimposed preeclampsia (aOR, 1.34; 95% CI, 1.15−1.56), gestational diabetes (aOR, 1.11; 95% CI, 1.03−1.19), placental abruption (aOR, 1.22; 95% CI, 1.09−1.36), and placenta previa (aOR, 1.30; 95% CI, 1.08−1.56). Asthmatic women had a higher odds of preterm birth overall (aOR, 1.17; 95% CI, 1.12−1.23) and of medically indicated preterm delivery (aOR, 1.14; 95% CI, 1.01−1.29). Asthmatics were less likely to have spontaneous labor (aOR, 0.87; 95% CI, 0.84−0.90) and vaginal delivery (aOR, 0.84; 95% CI, 0.80−0.87). Risks were higher for breech presentation (aOR, 1.13; 95% CI, 1.05−1.22), hemorrhage (aOR, 1.09; 95% CI, 1.03−1.16), pulmonary embolism (aOR, 1.71; 95% CI, 1.05−2.79), and maternal intensive care unit admission (aOR, 1.34; 95% CI, 1.04−1.72). Conclusion Maternal asthma increased risk for nearly all outcomes studied in a general obstetric population.
Neonatal health of infants born to mothers with asthma Mendola, Pauline, PhD; Männistö, Tuija I., MD, PhD; Leishear, Kira, PhD ...
Journal of allergy and clinical immunology,
01/2014, Letnik:
133, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Background Maternal asthma is associated with serious pregnancy complications, but newborn morbidity is understudied. Objective We wanted to determine whether infants of asthmatic mothers have more ...neonatal complications. Methods The Consortium on Safe Labor (2002-2008), a retrospective cohort, included 223,512 singleton deliveries at ≥23 weeks' gestation. Newborns of mothers with asthma (n = 17,044) were compared with newborns of women without asthma by using logistic regression models with generalized estimating equations to calculate adjusted odds ratios (ORs) and 95% CIs. Electronic medical record data included gestational week at delivery, birth weight, resuscitation, neonatal intensive care unit (NICU) admission, NICU length of stay, hyperbilirubinemia, respiratory distress syndrome, apnea, sepsis, anemia, transient tachypnea of the newborn, infective pneumonia, asphyxia, intracerebral hemorrhage, seizure, cardiomyopathy, periventricular or intraventricular hemorrhage, necrotizing enterocolitis, aspiration, retinopathy of prematurity, and perinatal mortality. Results Preterm delivery was associated with maternal asthma for each week after 33 completed weeks of gestation and not earlier. Maternal asthma also increased the adjusted odds of small for gestational age (OR = 1.10; 95% CI, 1.05-1.16), NICU admission (OR = 1.12; 95% CI, 1.07-1.17), hyperbilirubinemia (OR = 1.09; 95% CI, 1.04-1.14), respiratory distress syndrome (OR = 1.09; 95% CI, 1.01-1.19), transient tachypnea of the newborn (OR = 1.10; 95% CI, 1.02-1.19), and asphyxia (OR = 1.34; 95% CI, 1.03-1.75). Findings persisted for term infants (≥37 weeks) who had additional increased odds of intracerebral hemorrhage (OR = 1.84; 95% CI, 1.11-3.03) and anemia (OR = 1.30; 95% CI, 1.04-1.62). Conclusions Maternal asthma was associated with prematurity and small for gestational age. Adverse neonatal outcomes, including respiratory complications, hyperbilirubinemia, and NICU admission, were increased in association with maternal asthma even among term deliveries.
Adequate maternal thyroid function is important for an uncomplicated pregnancy. Although multiple observational studies have evaluated the association between thyroid dysfunction and hypertensive ...disorders of pregnancy, the methods and definitions of abnormalities in thyroid function tests were heterogeneous, and the results were conflicting. We aimed to examine the association between abnormalities in thyroid function tests and risk of gestational hypertension and pre-eclampsia.
In this systematic review and meta-analysis of individual-participant data, we searched MEDLINE (Ovid), Embase, Scopus, and the Cochrane Database of Systematic Reviews from date of inception to Dec 27, 2019, for prospective cohort studies with data on maternal concentrations of thyroid-stimulating hormone (TSH), free thyroxine (FT
), thyroid peroxidase (TPO) antibodies, individually or in combination, as well as on gestational hypertension, pre-eclampsia, or both. We issued open invitations to study authors to participate in the Consortium on Thyroid and Pregnancy and to share the individual-participant data. We excluded participants who had pre-existing thyroid disease or multifetal pregnancy, or were taking medications that affect thyroid function. The primary outcomes were documented gestational hypertension and pre-eclampsia. Individual-participant data were analysed using logistic mixed-effects regression models adjusting for maternal age, BMI, smoking, parity, ethnicity, and gestational age at blood sampling. The study protocol was registered with PROSPERO, CRD42019128585.
We identified 1539 published studies, of which 33 cohorts met the inclusion criteria and 19 cohorts were included after the authors agreed to participate. Our study population comprised 46 528 pregnant women, of whom 39 826 (85·6%) women had sufficient data (TSH and FT
concentrations and TPO antibody status) to be classified according to their thyroid function status. Of these women, 1275 (3·2%) had subclinical hypothyroidism, 933 (2·3%) had isolated hypothyroxinaemia, 619 (1·6%) had subclinical hyperthyroidism, and 337 (0·8%) had overt hyperthyroidism. Compared with euthyroidism, subclinical hypothyroidism was associated with a higher risk of pre-eclampsia (2·1% vs 3·6%; OR 1·53 95% CI 1·09-2·15). Subclinical hyperthyroidism, isolated hypothyroxinaemia, or TPO antibody positivity were not associated with gestational hypertension or pre-eclampsia. In continuous analyses, both a higher and a lower TSH concentration were associated with a higher risk of pre-eclampsia (p=0·0001). FT
concentrations were not associated with the outcomes measured.
Compared with euthyroidism, subclinical hypothyroidism during pregnancy was associated with a higher risk of pre-eclampsia. There was a U-shaped association of TSH with pre-eclampsia. These results quantify the risks of gestational hypertension or pre-eclampsia in women with thyroid function test abnormalities, adding to the total body of evidence on the risk of adverse maternal and fetal outcomes of thyroid dysfunction during pregnancy. These findings have potential implications for defining the optimal treatment target in women treated with levothyroxine during pregnancy, which needs to be assessed in future interventional studies.
Arkansas Biosciences Institute and Netherlands Organization for Scientific Research.
Context: There are only a few large prospective studies involving evaluation of the effect of maternal thyroid dysfunction on offspring and observations are inconsistent.
Objective: The objective of ...the study was to investigate the effects of thyroid dysfunction or antibody positivity on perinatal outcome.
Setting and Participants: The study included prospective population-based Northern Finland Birth Cohort 1986 including 9247 singleton pregnancies. First-trimester maternal serum samples were analyzed for thyroid hormones TSH, free T4 (fT4) and antibodies thyroid-peroxidase antibody (TPO-Ab) and thyroglobulin antibody (TG-Ab). Mothers were classified by their hormone and antibody status into percentile categories based on laboratory data and compared accordingly.
Main Outcomes: Outcomes were perinatal mortality, preterm delivery, absolute and gestational age-adjusted birth weight, and absolute and relative placental weight.
Results: The offspring of TPO-Ab- and TG-Ab-positive mothers had higher perinatal mortality, which was not affected by thyroid hormone status. Unadjusted and adjusted (for maternal age and parity) risk for increased perinatal mortality was an odds ratio of 3.1 (95% confidence interval 1.4–7.1) and 3.2 (1.4–7.1) in TPO-Ab- and 2.6 (1.1–6.2) and 2.5 (1.1–5.9) in TG-Ab-positive mothers. TPO-Ab-positive mothers had more large-for-gestational age infants (2.4 vs. 0.8%, P = 0.017), as did mothers with low TSH and high fT4 concentrations vs. reference group (6.6 vs. 2.5%, P = 0.045). Significantly higher placental weights were observed among mothers with low TSH and high fT4 or high TSH and low fT4 levels as well as among TPO-Ab-positive mothers.
Conclusions: First-trimester antibody positivity is a risk factor for perinatal death but not thyroid hormone status as such. Thyroid dysfunction early in pregnancy seems to affect fetal and placental growth.
Thyroid autoantibodies seem to have an adverse effect on perinatal outcome and therefore their screening might be advisable.
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