Download PDF
Horm Metab Res 2016; 48(01): 20-26
DOI: 10.1055/s-0035-1555878
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Maternal Thyroid Function and Autoimmunity in 3 Trimesters of Pregnancy and their Offspring’s Thyroid Function

P. Sarkhail
1   Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, I. R. Iran
,
L. Mehran
1   Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, I. R. Iran
,
S. Askari
1   Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, I. R. Iran
,
Z. Tahmasebinejad
1   Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, I. R. Iran
,
M. Tohidi
2   Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, I. R. Iran
,
F. Azizi
1   Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, I. R. Iran
› Author Affiliations
Further Information

Publication History

received 08 November 2014

accepted 23 June 2015

Publication Date:
13 November 2015 (online)

Also available at
    Permissions and Reprints

Abstract

This study was performed to evaluate maternal thyroid dysfunction and autoimmunity during pregnancy and its correlation with thyroid function of offspring. In this cohort study, Serum TT4, TT3, T3U, TSH, TPOAb, and TgAb were measured. Serum samples of 120 pregnant women were collected during 3 trimesters as well as in 57 cord bloods, 69 neonates, 34, 37, and 36 infants aged 2, 4, and 6 months. Repeated measure and Pearson correlation test were used to compare thyroid hormone values and to assess the correlations, respectively. Main outcomes were correlations between thyroid hormones and antibodies in mothers and offspring. An increasing trend for TT3 (p for trend < 000.1) and TSH (p for trend 0.01) was found over the course of gestation. Among 120 mothers, 10 (8%) had subclinical hyperthyroidism and 18 mothers (15%) showed subclinical hypothyroidism. We found one hypothyroid (0.8%) and 3 hyperthyroid (2.5%) mothers during pregnancy. Correlations among maternal thyroid hormones were found but not with auto-antibodies. A positive correlation between maternal thyroid auto-antibodies in all trimesters with cord blood and neonates was found. Cord blood TSH had a good correlation with maternal TSH, but only in the first trimester (r=0.29, p<0.05). A positive correlation between neonatal TSH and maternal TT4 was found only in the third trimester (r=0.25, p<0.05). Subclinical hypothyroidism was the most common thyroid dysfunction in the pregnant women studied. The association between maternal auto-antibodies and thyroid hormones of offspring was observed mostly in the neonatal period and became weaker after one month of age.

Key words

thyroid hormones - antibodies - pregnancy - cord blood - neonates - infants
 

  • References

  • 1 Dobbing J. The later growth of the brain and its vulnerability. J Pediatr 1974; 53: 2-6
    PubMedGoogle Scholar
  • 2 Fisher DA, Brown RS. Thyroid physiology in the perinatal period and during childhood. Braverman LE, Utiger RD. (eds.) Werner Ingbar’s The Thyroid: A Fundamental and Clinical Text. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2000: 824-827
    Google Scholar
  • 3 Peleg D, Cada S, Peleg A, Ben-Ami M. The relationship between maternal serum thyroid-stimulating immunoglobulin and fetal and neonatal thyrotoxicosis. Obstet Gynecol 2002; 99: 1040-1043
    CrossrefPubMedGoogle Scholar
  • 4 Smallridge RC. Postpartum thyroid disease: a model of immunologic dysfunction. Clin Appl Immunol Rev 2000; 1: 89-103
    CrossrefPubMedGoogle Scholar
  • 5 Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002; 87: 489-499
    Google Scholar
  • 6 Klein RZ, Haddow JE, Faix JD, Brown RS, Hermos RJ, Pulkkinen A, Mitchell ML. Prevalence of thyroid deficiency in pregnant women. Clin Endocrinol 1991; 35: 41-46
    CrossrefPubMedGoogle Scholar
  • 7 Allan WC, Haddow JE, Palomaki GE, Williams JR, Mitchell ML, Hermos RJ, Faix JD, Klein RZ. Maternal thyroid deficiency and pregnancy complications: Implications for population screening. J Med Screen 2000; 7: 127-130
    CrossrefPubMedGoogle Scholar
  • 8 Kamijo K, Saito T, Sato M, Yachi A, Mukai A, Fukusi M, Takasugi N. Transient subclinical hypothyroidism in early pregnancy. Endocrinol Jpn 1990; 37: 397-403
    CrossrefPubMedGoogle Scholar
  • 9 Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev 1997; 18: 404-433
    CrossrefPubMedGoogle Scholar
  • 10 Ultiger RD. Maternal hypothyroidism and fetal development. N Engl J Med 1999; 341: 601-602
    CrossrefPubMedGoogle Scholar
  • 11 Fisher DA, Pandian MR, Carlton E. Autoimmune thyroid disease: an expanding spectrum. Pediatr Clin North Am 1987; 34: 907-918
    PubMedGoogle Scholar
  • 12 Foley Jr TP. Mediators of thyroid diseases in children. J Pediatr 1998; 132: 569-570
    CrossrefPubMedGoogle Scholar
  • 13 Ghassabian A, Bongers-Schokking JJ, de Rijke YB, van Mil N, Jaddoe VW, de Muinck Keizer-Schrama SM, Hooijkaas H, Hofman A, Visser W, Roman GC, Visser TJ, Verhulst FC, Tiemeier H. Maternal Thyroid Autoimmunity during Pregnancy and the Risk of Attention deficit/Hyperactivity Problems in Children: The Generation R Study. Thyroid 2012; 22: 178-186
    CrossrefPubMedGoogle Scholar
  • 14 Matsuura N, Yamada Y, Nohara Y, Konishi J, Kasagi K, Endo K, Kojima H, Wataya K. Familial neonatal transient hypothyroidism due to maternal TSH binding inhibiting immunoglobulins. N Engl J Med 1980; 303: 738-741
    CrossrefPubMedGoogle Scholar
  • 15 Dussault JH, Letarte J, Guyda H, Laberge C. Lack of influence of thyroid antibodies on thyroid function in the newborn infant and on a mass screening program for congenital hypothyroidism. J Pediatr 1980; 96: 385-389
    CrossrefPubMedGoogle Scholar
  • 16 Rovelli R, Vigone MC, Giovanettoni C, Passoni A, Maina L, Corrias A, Corbetta C, Mosca F, Chiumello G, Weber G. Newborn of mothers affected by autoimmune thyroiditis: the importance of thyroid function monitoring in the first months of life. Ital J Pediatr 2010; 36: 24
    CrossrefPubMedGoogle Scholar
  • 17 Männistö T, Surcel HM, Ruokonen A, Vääräsmäki M, Pouta A, Bloigu A, Järvelin MR, Hartikainen AL, Suvanto E. Early pregnancy reference intervals of thyroid hormone concentrations in a thyroid antibody-negative pregnant population. Thyroid 2011; 21: 291-298
    CrossrefPubMedGoogle Scholar
  • 18 Pop VJ, Kuijpens JL, van Baar AL, Verkerk G, van Son MM, de Vijlder JJ, Vulsma T, Wiersinga WM, Drexhage HA, Vader HL. Low maternal free thyroxine concentrations during early pregnancy are associated with impaired psychomotor development in infancy. Clin Endocrinol (Oxf) 1999; 50: 149-155
    CrossrefPubMedGoogle Scholar
  • 19 Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Thyroid antibody positivity in the first trimester of pregnancy is associated with negative pregnancy outcomes. J Clin Endocrinol Metab 2011; 96: E920-E924
    CrossrefPubMedGoogle Scholar
  • 20 Mehran L, Amouzegar A, Delshad H, Askari S, Hedayati M, Amirshekari G, Azizi F. Trimester-Specific Reference Ranges for Thyroid Hormones in Iranian Pregnant Women. J Thyroid Res 2013; 651517
    PubMedGoogle Scholar
  • 21 Pescovitz OH, Eugster EA. Pediatric Endocrinology: Mechanisms, Manifestations, and management. Philadelphia: Lippincott Williams & Wilkins; 2004: 781-784
    Google Scholar
  • 22 Glinoer D. The regulation of thyroid function during normal pregnancy: importance of the iodine nutrition status. Best Pract Res Clin Endocrinol Metab 2004; 18: 133-152
    CrossrefPubMedGoogle Scholar
  • 23 Glinoer D, de Nayer P, Bourdoux P, Lemone M, Robyn C, van Steirteghem A, Kinthaert J, Lejdeune B. Regulation of maternal thyroid during pregnancy. J Clin Endocrinol Metab 1990; 71: 276-287
    CrossrefPubMedGoogle Scholar
  • 24 Glinoer D, Riahi M, Grün JP, Kinthaert J. Risk of subclinical hypothyroidism in pregnant women with asymptomatic autoimmune thyroid disorders. J Clin Endocrinol Metab 1994; 79: 197-204
    PubMedGoogle Scholar
  • 25 Soldin OP, Soldin D, Sastoque M. Gestation-specific thyroxine and thyroid stimulating hormone levels in the United States and world wide. Ther Drug Monit 2007; 29: 553-539
    CrossrefPubMedGoogle Scholar
  • 26 Berghout A, Wiersinga W. Thyroid size and thyroid function during pregnancy: an analysis. Eur J Endocrinol 1998; 138: 536-542
    CrossrefPubMedGoogle Scholar
  • 27 Hopton MR, Ashwell K, Scott IV, Harrop JS. Serum free thyroxine concentration and free thyroid hormone indices in normal pregnancy. Clin Endocrinol (Oxf) 1983; 18: 431-437
    CrossrefPubMedGoogle Scholar
  • 28 Soldin OP, Tractenberg RE, Hollowell JG, Jonklaas J, Janicic N, Soldin SJ. Trimester-specific changes in maternal thyroid hormone, thyrotropin, and thyroglobulin concentrations during gestation: trends and associations across trimesters in iodine sufficiency. Thyroid 2004; 14: 1084-1090
    CrossrefPubMedGoogle Scholar
  • 29 Dhatt GS, Jayasundaramb R, WarethLA Nagelkerked N, Jayasundaramc K, Ali Darwish E, Lewis A. Thyrotrophin and free thyroxine trimester-specific reference intervals in a mixed ethnic pregnant population in the United Arab Emirates. Clin Chim Acta 2006; 370: 147-151
    CrossrefPubMedGoogle Scholar
  • 30 Haddow JE, Knight GJ, Palomaki GE, McClain MR, Pulkkinen AJ. Reference range and within-person variability of thyroid stimulating hormone during the first and second trimesters of pregnancy. J Med Screen 2004; 11: 170-174
    CrossrefPubMedGoogle Scholar
  • 31 Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab 2006; 91: 2587-2591
    CrossrefPubMedGoogle Scholar
  • 32 McClain MR, Lambert-Messerlian G, Haddow JE, Palomaki GE, Canick JA, Cleary-Goldman J, Malone FD, Porter TF, Nyberg DA, Bernstein P, D’Alton ME. FaSTER Research Consortium . Sequential first- and second-trimester TSH, free thyroxine, and thyroid antibody measurements in women with known hypothyroidism: a FaSTER trial study. Am J Obstet Gynecol 2008; 199: 129.e1-129.e6
    CrossrefPubMedGoogle Scholar
  • 33 Shields BM, Knight BA, Hill A, Hattersley AT, Vaidya B. Fetal thyroid hormone level at birth is associated with fetal growth. J Clin Endocrinol Metab 2011; 96: E934-E938
    Google Scholar
  • 34 Kuppens SM, Kooistra L, Wijnen HA, Vader HL, Hasaart TH, Oei SG, Vulsma T, Pop VJ. Neonatal thyroid screening results arerelated to gestational maternal thyroid function. Clin Endocrinol (Oxf) 2011; 75: 382-387
    CrossrefPubMedGoogle Scholar
  • 35 Ordookhani A, Mirmiran P, Walfish PG, Azizi F. Transient Neonatal Hypothyroidism is Associated with Elevated Serum Anti-Thyroglobulin Antibody Levels in Newborns and Their Mothers. J Pediatr 2007; 150: 315-317
    CrossrefPubMedGoogle Scholar
  • 36 Dussault JH, Fisher DA. Thyroid function in mothers of hypothyroid newborns. Obstet Gynecol 1999; 93: 15-20
    CrossrefPubMedGoogle Scholar
  • 37 Fisher DA. Fetal thyroid function: diagnosis and management of fetal thyroid disorders. Clin Obstet Gynecol 1997; 40: 16-31
    CrossrefPubMedGoogle Scholar
  • 38 Bech K, Hertel J, Rasmussen NG, Hegedüs L, Hornnes PJ, Feldt-Rasmussen U, Høier-Madsen M. Effect of maternal thyroid autoantibodies and post-partum thyroiditis on the fetus and neonates. Acta Endocrinol (Copenh) 1991; 125: 146-149
    PubMedGoogle Scholar
  • 39 Ozdemir H, Akman I, Coskun S, Demirel U, Turan S, Bereket A, Bilgen H, Ozek E. Maternal thyroid dysfunction and neonatal thyroid problems. Int J Endocrinol 2013; 987843
    PubMedGoogle Scholar