Maternal Hypothyroidism during Pregnancy and the Risk for Infectious Morbidity of the Offspring

Ofer Beharier; Asnat Walfisch; Tamar Wainstock; Irit Szaingurten-Solodkin; Daniela Landau; Eyal Sheiner

doi:10.1055/s-0039-3400980

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2020; 37(03): 291-295
DOI: 10.1055/s-0039-3400980

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Maternal Hypothyroidism during Pregnancy and the Risk for Infectious Morbidity of the Offspring

Ofer Beharier

¹Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

,

Asnat Walfisch

²Department of Obstetrics and Gynecology, Mt. Scopus Hospital, Hadassah Medical Center, Jerusalem, Israel

,

Tamar Wainstock

³Department of Public Health, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

,

Irit Szaingurten-Solodkin

¹Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

,

Daniela Landau

⁴Department of Pediatrics, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

,

Eyal Sheiner

¹Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

› Institutsangaben

Abstract

Objective Animal studies indicate a possible intrauterine immunological imprinting in pregnancies complicated by hypothyroidism. We aimed to evaluate whether exposure to maternal hypothyroidism during pregnancy increases the risk of long-term infectious morbidity of the offspring.

Study Design A retrospective cohort study compared the long-term risk of hospitalization associated with infectious morbidity in children exposed and unexposed in utero to maternal hypothyroidism. Outcome measures included infectious diagnoses obtained during any hospitalization of the offspring (up to the age of 18 years).

Results The study included 224,950 deliveries. Of them, 1.1% (n = 2,481) were diagnosed with maternal hypothyroidism. Children exposed to maternal hypothyroidism had a significantly higher rate of hospitalizations related to infectious morbidity (13.2 vs. 11.2% for control; odds ratio: 1.2; 95% confidence interval: 1.08–1.36; p = 0.002). Specifically, incidences of ear, nose, and throat; respiratory; and ophthalmic infections were significantly higher among the exposed group. The Kaplan–Meier curve indicated that children exposed to maternal hypothyroidism had higher cumulative rates of long-term infectious morbidity. In the Cox proportional hazards model, maternal hypothyroidism remained independently associated with an increased risk of infectious morbidity in the offspring while adjusting for confounders.

Conclusion Maternal hypothyroidism during pregnancy is associated with significant pediatric infectious morbidity of the offspring.

Keywords

hypothyroidism - pregnancy - long-term infectious morbidity - retrospective cohort study

Volltext

Referenzen

References
1 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 (08) 2543-2565
2 Cohen N, Levy A, Wiznitzer A, Sheiner E. Perinatal outcomes in post-thyroidectomy pregnancies. Gynecol Endocrinol 2011; 27 (05) 314-318
3 Männistö T, Mendola P, Grewal J, Xie Y, Chen Z, Laughon SK. Thyroid diseases and adverse pregnancy outcomes in a contemporary US cohort. J Clin Endocrinol Metab 2013; 98 (07) 2725-2733
4 Nazarpour S, Ramezani Tehrani F, Simbar M, Azizi F. Thyroid dysfunction and pregnancy outcomes. Iran J Reprod Med 2015; 13 (07) 387-396
5 de Escobar GM, Obregón MJ, del Rey FE. Maternal thyroid hormones early in pregnancy and fetal brain development. Best Pract Res Clin Endocrinol Metab 2004; 18 (02) 225-248
6 Haddow JE, Palomaki GE, Allan WC. , et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999; 341 (08) 549-555
7 Forhead AJ, Fowden AL. Thyroid hormones in fetal growth and prepartum maturation. J Endocrinol 2014; 221 (03) R87-R103
8 Andersen SL, Olsen J, Laurberg P. Foetal programming by maternal thyroid disease. Clin Endocrinol (Oxf) 2015; 83 (06) 751-758
9 Fowden AL, Giussani DA, Forhead AJ. Intrauterine programming of physiological systems: causes and consequences. Physiology (Bethesda) 2006; 21: 29-37
10 Sferruzzi-Perri AN, Camm EJ. The programming power of the placenta. Front Physiol 2016; 7: 33
11 Nahum Sacks K, Friger M, Shoham-Vardi I. , et al. Prenatal exposure to gestational diabetes mellitus as an independent risk factor for long-term neuropsychiatric morbidity of the offspring. Am J Obstet Gynecol 2016; 215 (03) 380.e1-380.e7
12 Rees S, Harding R, Walker D. An adverse intrauterine environment: implications for injury and altered development of the brain. Int J Dev Neurosci 2008; 26 (01) 3-11
13 Opazo MC, Haensgen H, Bohmwald K. , et al. Imprinting of maternal thyroid hormones in the offspring. Int Rev Immunol 2017; 36 (04) 240-255
14 Erf GF. Immune development in young-adult C.RF-hyt mice is affected by congenital and maternal hypothyroidism. Proc Soc Exp Biol Med 1993; 204 (01) 40-48
15 Gala RR. Influence of thyroxine and thyroxine with growth hormone and prolactin on splenocyte subsets and on the expression of interleukin-2 and prolactin receptors on splenocyte subsets of Snell dwarf mice. Proc Soc Exp Biol Med 1995; 210 (02) 117-125
16 Albornoz EA, Carreño LJ, Cortes CM. , et al. Gestational hypothyroidism increases the severity of experimental autoimmune encephalomyelitis in adult offspring. Thyroid 2013; 23 (12) 1627-1637
17 Nieto PA, Peñaloza HF, Salazar-Echegarai FJ. , et al. Gestational hypothyroidism improves the ability of the female offspring to clear Streptococcus pneumoniae infection and to recover from pneumococcal pneumonia. Endocrinology 2016; 157 (06) 2217-2228
18 Andersen SL, Carlé A, Karmisholt J, Pedersen IB, Andersen S. MECHANISMS IN ENDOCRINOLOGY: Neurodevelopmental disorders in children born to mothers with thyroid dysfunction: evidence of fetal programming?. Eur J Endocrinol 2017; 177 (01) R27-R36
19 Villa-Verde DM, de Mello-Coelho V, Farias-de-Oliveira DA, Dardenne M, Savino W. Pleiotropic influence of triiodothyronine on thymus physiology. Endocrinology 1993; 133 (02) 867-875
20 Polak M. Human fetal thyroid function. Endocr Dev 2014; 26: 17-25
21 Holt PG, Jones CA. The development of the immune system during pregnancy and early life. Allergy 2000; 55 (08) 688-697
22 Sarkhail P, Mehran L, Askari S, Tahmasebinejad Z, Tohidi M, Azizi F. Maternal thyroid function and autoimmunity in 3 trimesters of pregnancy and their offspring's thyroid function. Horm Metab Res 2016; 48 (01) 20-26
23 Velasco I, Martín J, Gallego M. , et al. Maternal-fetal thyroid function at the time of birth and its relation with iodine intake. Thyroid 2013; 23 (12) 1619-1626
24 Bernstein JM, Tsutsumi H, Ogra PL. The middle ear mucosal immune system in otitis media with effusion. Am J Otolaryngol 1985; 6 (03) 162-168