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CC BY 4.0 · Rev Bras Ginecol Obstet 2021; 43(10): 736-742
DOI: 10.1055/s-0041-1736172
Original Article
Obstetrics

Thyroid Function of Pregnant Women and Perinatal Outcomes in North Macedonia

Função tireoidiana de mulheres grávidas e resultados perinatais na Macedônia do Norte
Maja Avramovska 
1   Department of Obstetrics and Gynecology, Clinical Hospital “Dr. Trifun Panovski” - Bitola, Partizanska nn, North Macedonia
,
Neda Milevska Kostova 
2   Departement Gesundheitswissenschaften und Technologie, Institute for Social Innovation, Skopje, Skopje, North Macedonia
,
Borislav Karanfilski 
3   National Committee for Iodine Deficiency, Ministry of Health, Skopje, North Macedonia
,
Sandra Hunziker 
4   Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland
,
Olivija Vaskova 
5   Institute of Pathophysiology and Nuclear Medicine, Faculty of Medicine, Ss. Cyril and Methodius University Skopje, Skopje, North Macedonia
,
Goran Dimitrov 
6   University Clinic of Gynecology and Obstetrics, Faculty of Medicine, Ss. Cyril and Methodius University Skopje, Skopje, North Macedonia
,
Elena Dzikova 
6   University Clinic of Gynecology and Obstetrics, Faculty of Medicine, Ss. Cyril and Methodius University Skopje, Skopje, North Macedonia
,
Ana Daneva Markova 
6   University Clinic of Gynecology and Obstetrics, Faculty of Medicine, Ss. Cyril and Methodius University Skopje, Skopje, North Macedonia
,
Marija Hadzi Lega 
7   Department for Fetal Screening and Perinatal Medicine, Danat al Emarat Hospital for Women and Children, Abu Dhabi, Emirate of Abu Dhabi
,
Gligor Tofoski 
6   University Clinic of Gynecology and Obstetrics, Faculty of Medicine, Ss. Cyril and Methodius University Skopje, Skopje, North Macedonia
,
Aleksandar Sikole 
8   Department of Nephrology, University Clinic of Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University Skopje, Skopje, North Macedonia
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Abstract

Objective Thyroid diseases are the second most common endocrine disorders in the reproductive period of women. They can be associated with intrauterine growth restriction (IUGR), preterm delivery, low Apgar score, low birthweight (LBW) or fetal death. The aim of the present study is to explore thyroid dysfunction and its relationship with some poor perinatal outcomes (Apgar Score, low birthweight, and preterm delivery).

Methods Dried blood spot samples from 358 healthy pregnant women were analyzed for thyroid stimulating hormone (TSH), total thyroxine (TT4), and thyroglobulin (Tg). Neonatal data were collected upon delivery. Four groups were formed based on thyroid function tests (TFTs).

Results Of the 358 tested women, 218 (60.72%) were euthyroid. Isolated hypothyroxinemia was present in 132 women (36.76%), subclinical hyperthyroidism in 7 women (1.94%), and overt hypothyroidism in 1 (0.28%). The perinatal outcomes IUGR (p = 0.028) and Apgar score 1 minute (p = 0.015) were significantly different between thyroid function test [TFT]-distinct groups. In the multiple regression analysis, TT4 showed a statistically significant inverse predictive impact on LBW (p < 0.0001), but a positive impact of Tg on LBW (p = 0.0351).

Conclusion Thyroid hormones alone do not have a direct impact on neonatal outcomes, but the percentage of their participation in the total process cannot be neglected. Based on the regression analysis, we can conclude that TT4 and Tg can be used as predictors of neonatal outcome, expressed through birthweight and Apgar score. The present study aims to contribute to determine whether a test for thyroid status should become routine screening during pregnancy.

Resumo

Objetivo As doenças da tireoide são as segundas doenças endócrinas mais comuns no período reprodutivo das mulheres. Elas podem estar associadas à restrição de crescimento intrauterino (RCIU), parto prematuro, baixo índice de Apgar, baixo peso ao nascer (BPN) ou morte fetal. O objetivo do presente estudo é explorar a disfunção tireoidiana e sua relação com alguns resultados perinatais insatisfatórios (índice de Apgar, baixo peso ao nascer e parto prematuro).

Métodos Amostras secas de sangue em 358 gestantes saudáveis foram analisadas para hormônio estimulador da tireoide (TSH), tiroxina total (TT4) e tireoglobulina (Tg). Os dados neonatais foram coletados no momento do parto. Quatro grupos foram formados com base em testes de função tireoidiana (TFT).

Resultados Das 358 mulheres testadas, 218 (60,72%) eram eutireoidianas. Hipotiroxinemia isolada estava presente em 132 mulheres (36,76%), hipertireoidismo subclínico em 7 mulheres (1,94%) e hipotireoidismo evidente em 1 (0,28%). Os resultados perinatais RCIU (p = 0,028) e índice de Apgar de 1 minuto (p = 0,015) foram significativamente diferentes entre os grupos distintos de TFT. Na análise de regressão múltipla, TT4 mostrou impacto preditivo inverso estatisticamente significativo no BPN (p < 0,0001), mas impacto positivo da Tg no BPN (p = 0,0351).

Conclusão Isoladamente, os hormônios tireoidianos não têm impacto direto no desfecho neonatal, mas o percentual de sua participação no processo total não pode ser desprezado. Com base na análise de regressão, podemos concluir que TT4 e Tg podem ser usados como preditores do resultado neonatal, expressos por meio do peso ao nascer e do índice de Apgar. O presente estudo tem como objetivo contribuir para que um teste para verificar o estado da tireoide deva se tornar um rastreamento de rotina durante a gravidez.

Keywords

thyroid stimulating hormone - total thyroxine - thyroglobulin - perinatal outcomes - low birth weight

Palavras-chave

hormônio estimulante da tireoide - tiroxina total - tireoglobulina - resultados perinatais - baixo peso de nascimento

Contributions

All authors participated in the concept and design of the present study; in the analysis and interpretation of data; in the elaboration of the draft or in the revision of the manuscript; and they have approved the manuscript as submitted. All authors are responsible for the reported research.




Publication History

Received: 04 December 2020

Accepted: 09 August 2021

Article published online:
16 November 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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