Download PDF
CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2023; 83(11): 1361-1370
DOI: 10.1055/a-2103-8143
GebFra Science
Original Article

Reducing the Rate of Premature Births through Early Diagnosis and Pregnancy-Adapted Treatment of Hypothyroidism

Article in several languages: English | deutsch
Pompilio Torremante
1   Frauenarzt/Spezielle Geburtshilfe und Perinatalmedizin, Ochsenhausen, Germany
,
Nils Kristian Berge
2   Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Universitätsmedizin Mannheim, Ruprecht-Karls-Universität Heidelberg Medizinische Fakultät Mannheim, Mannheim, Germany (Ringgold ID: RIN99045)
,
Christel Weiss
2   Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Universitätsmedizin Mannheim, Ruprecht-Karls-Universität Heidelberg Medizinische Fakultät Mannheim, Mannheim, Germany (Ringgold ID: RIN99045)
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction

The aim of this study was to determine the extent to which regular monitoring of maternal free thyroxine level and pregnancy-adapted L-thyroxine replacement therapy before and during pregnancy in patients with existing or newly diagnosed latent and manifest hypothyroidism as well as hypothyroxinemia can influence the rate of premature births.

Materials and Methods

This is a retrospective cohort study assessing 1440 pseudonymized survey questionnaires to evaluate the risks of premature birth with two study groups from the same medical practice, and a nationally recruited control group. Study group A (n = 360) had already been taking L-thyroxine prior to conception, study group B (n = 580) started taking it after conception. Both study groups had a maximum gestational age of 12 + 0 GW. In the study groups, TSH and free thyroxine levels were determined regularly for dose adjustment purposes. The aim was to keep the free thyroxine level in the euthyroid hyperthyroxinemic range within the pregnancy adapted reference range. The control group (n = 500) had taken L-thyroxine during pregnancy according to criteria that were not known, as the questionnaire did not include any questions regarding this matter. Taking other risk factors into account, the influence of pregnancy-adapted L-thyroxine replacement therapy on the rate of premature births was determined using logistic regression analysis.

Results

Compared with the control group, the premature birth rate was 70% lower (p < 0.0001) in study group A and 42% lower in study group B (p = 0.0086), while the odds ratio, at 3.46, was particularly significant in study group A. High blood pressure (odds ratio 5.21), body mass index per kg/m2 (odds ratio 0.91) and S. p. premature birth were identified as other independent risk factors.

Conclusion

The results show an association between more intensive thyroid diagnostics and pregnancy-adapted L-thyroxine replacement therapy and a decrease in premature births. Further studies should be conducted to confirm these results.

Keywords

premature birth - hypothyroidism - thyroxine - hypothyroxinemia - obstetrics


Publication History

Received: 11 July 2022

Accepted after revision: 31 May 2023

Article published online:
05 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References/Literatur

  • 1 Stepan H, Verlohren S. Frühgeburtlichkeit. Frauenheilkunde up2date 2010; 4: 235-247
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Ivanov ID, Buzalov SA, Hinkova NA. Prevention of Preterm Birth. J Biomed Clin Res 2018; 11: 95-104
    CrossrefPubMedSearch in Google Scholar
  • 3 Institut für Qualitätssicherung und Transparenz im Gesundheitswesen (IQTIG). Bundesauswertung zum Erfassungsjahr 2017. Geburtshilfe. Qualitätsindikatoren. 01.08.2018 Accessed June 13, 2022 at: https://iqtig.org/downloads/auswertung/2017/16n1gebh/QSKH_16n1-GEBH_2017_BUAW_V02_2018–08–01.pdf
    PubMedSearch in Google Scholar
  • 4 Schleussner E. The prevention, diagnosis and treatment of premature labor. Dtsch Arztebl Int 2013; 110: 227-235
    CrossrefPubMedSearch in Google Scholar
  • 5 Abele H, Bahlmann F, Berger R. et al. Prävention und Therapie der Frühgeburt. Leitlinie der DGGG, OEGGG und SGGG (S2k-Niveau, AWMF-Registernummer 015/025. 2022 Accessed December 19, 2022 at: https://register.awmf.org/de/leitlinien/detail/015–025
    PubMedSearch in Google Scholar
  • 6 Euro-Peristat Project. European Perinatal Health Report Core indicators of the health and care of pregnant women and babies in Europe in 2015. 2018 Accessed June 13, 2022 at: https://www.europeristat.com/index.php/reports/european-perinatal-health-report-2015.html
    PubMedSearch in Google Scholar
  • 7 Berger R, Abele H, Bahlmann F. et al. Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry Number 015/025, September 2022) – Part 1 with Recommendations on the Epidemiology, Etiology, Prediction, Primary and Secondary Prevention of Preterm Birth. Geburtshilfe Frauenheilkd 2023; 83: 547-568
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Berger R, Abele H, Bahlmann F. et al. Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/025, September 2022) – Part 2 with Recommendations on the Tertiary Prevention of Preterm Birth and on the Management of Preterm Premature Rupture of Membranes. Geburtshilfe Frauenheilkd 2023; 83: 569-601
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Dudenhausen JW, Friese K, Kirschner W. Präkonzeptionelle Gesundheitsberatung und Beratung zur Wahl der Geburtsklinik als weitere Instrumente zur Verringerung von Frühgeburten. Z Geburtshilfe Neonatol 2007; 211: 142-146
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Korevaar M, Derakhshan A, Taylor PN. et al. Association of Thyroid Function Test Abnormalities and Thyroid Autoimmunity With Preterm Birth: A Systematic Review and Meta-analysis. JAMA 2019; 322: 632-664
    CrossrefPubMedSearch in Google Scholar
  • 11 Unuane D, Velkeniers B. Impact of thyroid disease on fertility and assisted conception. Best Pract Res Clin Endocrinol Metab 2020; 34: 101378
    CrossrefPubMedSearch in Google Scholar
  • 12 Nasirkandy MP, Badfar G, Shohani M. et al. The relation of maternal hypothyroidism and hypothyroxinemia during pregnancy on preterm birth: An updated systematic review and meta-analysis. Int J Reprod Biomed 2017; 15: 543-552
    CrossrefPubMedSearch in Google Scholar
  • 13 Dosiou C, Medici M. Management of Endocrine Disease: Isolated maternal hypothyroxinemia during pregnancy: knowns and unknowns. Eur J Endocrinol 2017; 176: 21-38
    CrossrefPubMedSearch in Google Scholar
  • 14 De Groot L, Abalovich M, Alexander EK. et al. Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2012; 97: 2543-2565
    CrossrefPubMedSearch in Google Scholar
  • 15 Alexander EK, Pearce EN, Brent GA. et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid 2017; 27: 315-389
    CrossrefPubMedSearch in Google Scholar
  • 16 Lazarus J, Brown RS, Daumerie C. et al. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J 2014; 3: 76-94
    CrossrefPubMedSearch in Google Scholar
  • 17 Koullali B, van Zijl MD, Kazemier BM. et al. The association between parity and spontaneous preterm birth: a population based study. BMC Pregnancy Childbirth 2020; 20: 233
    CrossrefPubMedSearch in Google Scholar
  • 18 Cavoretto P, Candiani M, Giorgione V. et al. Risk of spontaneous preterm birth in singleton pregnancies conceived after IVF/ICSI treatment: meta-analysis of cohort studies. Ultrasound Obstet Gynecol 2018; 51: 43-53
    CrossrefPubMedSearch in Google Scholar
  • 19 Díaz-Rodríguez A, Feliz-Matos L, Ruiz-Matuk CB. Risk factors associated with preterm birth in the Dominican Republic: a case-control study. BMJ Open 2021; 11: e045399
    CrossrefPubMedSearch in Google Scholar
  • 20 Reid SM, Middleton P, Cossich MC. et al. Interventions for clinical and subclinical hypothyroidism pre-pregnancy and during pregnancy. Cochrane Database Syst Rev 2013; (05) CD007752
    CrossrefPubMedSearch in Google Scholar
  • 21 Spencer L, Bubner T, Bain E. et al. Screening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health. Cochrane Database Syst Rev 2015; (09) CD011263
    CrossrefPubMedSearch in Google Scholar
  • 22 Runkle I, Paz de Miguel M, Barabash A. et al. Early Levothyroxine Treatment for Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy: The St Carlos Gestational and Thyroid Protocol. Front Endocrinol 2021; 12: 743057
    CrossrefPubMedSearch in Google Scholar
  • 23 Hamza A, Schlembach D, Schild RL. et al. Recommendations of the AGG (Working Group for Obstetrics, Department of Maternal Diseases) on How to Treat Thyroid Function Disorders in Pregnancy. Geburtshilfe Frauenheilkd 2023; 83: 504-516
    Thieme ConnectPubMedSearch in Google Scholar
  • 24 Korevaar TIM, Tiemeier H, Peeters RP. Clinical associations of maternal thyroid function with foetal brain development: Epidemiological interpretation and overview of available evidence. Clin Endocrinol (Oxf) 2018; 89: 129-138
    CrossrefPubMedSearch in Google Scholar
  • 25 Korevaar TI, de Rijke YB, Chaker L. et al. Stimulation of Thyroid Function by Human Chorionic Gonadotropin During Pregnancy: A Risk Factor for Thyroid Disease and a Mechanism for Known Risk Factors. Thyroid 2017; 27: 440-450
    CrossrefPubMedSearch in Google Scholar
  • 26 Torremante P. Die Schilddrüse in der gynäkologischen Sprechstunde. Menopause & Contraception 2012; 1: 1-11
    PubMedSearch in Google Scholar
  • 27 Vinturache A, McKeating A, Daly N. et al. Maternal body mass index and the prevalence of spontaneous and elective preterm deliveries in an Irish obstetric population: a retrospective cohort study. BMJ Open 2017; 7: e015258
    CrossrefPubMedSearch in Google Scholar
  • 28 Sua XJ, Huangb SJ, Li X. et al. Prepregnancy Overweight and Obesity Are Associated with an Increased Risk of Preterm Birth in Chinese Women. Obes Facts 2020; 13: 237-244
    CrossrefPubMedSearch in Google Scholar
  • 29 Silva FP, Souza RT, Cecatti JG. et al. Role of Body Mass Index and gestational weight gain on preterm birth and adverse perinatal outcomes. Sci Rep 2019; 9: 13093
    CrossrefPubMedSearch in Google Scholar
  • 30 Dudenhausen JW, Kunze M, Wittwer-Backofen U. et al. The relationship between maternal age, body mass index, and the rate of preterm birth. J Turk Ger Gynecol Assoc 2018; 19: 182-186
    CrossrefPubMedSearch in Google Scholar
  • 31 Jung YM, Oh GC, Noh E. et al. Pre-pregnancy blood pressure and pregnancy outcomes: a nationwide population-based study. BMC Pregnancy Childbirth 2022; 22: 226
    CrossrefPubMedSearch in Google Scholar