Download PDF
Am J Perinatol 2017; 34(14): 1447-1450
DOI: 10.1055/s-0037-1604289
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Effect of Treated Overt Hypothyroidism on Outcomes in Twin Pregnancies

Jonathan Y. Rosner
1   Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
,
Nathan S. Fox
2   Carnegie Imaging for Women, PLLC, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, Maternal Fetal Medicine Associates, PLLC New York, New York
,
Daniel Saltzman
2   Carnegie Imaging for Women, PLLC, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, Maternal Fetal Medicine Associates, PLLC New York, New York
,
Andrei Rebarber
2   Carnegie Imaging for Women, PLLC, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, Maternal Fetal Medicine Associates, PLLC New York, New York
,
Simi Gupta
2   Carnegie Imaging for Women, PLLC, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, Maternal Fetal Medicine Associates, PLLC New York, New York
› Author Affiliations
Further Information

Publication History

09 April 2017

13 June 2017

Publication Date:
13 July 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Objective The objective of this study was to determine if treatment of overt hypothyroidism in twin pregnancies reduces adverse outcomes associated with overt hypothyroidism in pregnancy.

Methods This is a retrospective cohort study of all patients who were presented with twin gestations between 2005 and 2013 to a single obstetrical practice. Patients who were diagnosed with overt hypothyroidism were identified. Patients were followed up with serial thyroid function tests and treated appropriately. Rates of adverse pregnancy outcomes were compared between patients with and without hypothyroidism with p < 0.05 used for significance.

Results In this study, 612 twin pregnancies were included; 85 patients were diagnosed with overt hypothyroidism. Patients with overt hypothyroidism were more likely to have had in vitro fertilization (78 vs. 62%; p < 0.01). After adjusting for confounding variables, patients with overt hypothyroidism had no increased risk of spontaneous preterm birth < 37 weeks' gestation (adjusted odds ratio [aOR]: 0.833; 95% confidence interval [CI]: 0.498–1.393), intrauterine growth restriction (aOR: 0.720; 95% CI: 0.446–1.163), gestational diabetes (aOR: 0.812; 95% CI: 0.353–1.871), or composite adverse outcomes (aOR: 0.659; 95% CI 0.391–1.111) compared with patients who did not have overt hypothyroidism. There was a trend toward decreased hypertensive disorders of pregnancy (aOR: 0.470; 95% CI: 0.234–0.944).

Conclusion Our study shows that in twin gestations, there is no increased risk of adverse pregnancy outcomes between patients with treated overt hypothyroidism and those without overt hypothyroidism.

Keywords

twins - hypothyroidism - adverse outcomes - levothyroxine

Note

The study was presented at the Society for Reproductive Investigation 62nd Annual Scientific Meeting, San Francisco, CA, March 25–28, 2015.


 

  • References

  • 1 American College of Obstetricians and Gynecologists. Practice Bulletin No. 148: thyroid disease in pregnancy. Obstet Gynecol 2015; 125 (04) 996-1005
    CrossrefPubMedGoogle Scholar
  • 2 Casey BM, Leveno KJ. Thyroid disease in pregnancy. Obstet Gynecol 2006; 108 (05) 1283-1292
    CrossrefPubMedGoogle Scholar
  • 3 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
    CrossrefPubMedGoogle Scholar
  • 4 Leung AS, Millar LK, Koonings PP, Montoro M, Mestman JH. Perinatal outcome in hypothyroid pregnancies. Obstet Gynecol 1993; 81 (03) 349-353
    PubMedGoogle Scholar
  • 5 Nathan N, Sullivan SD. Thyroid disorders during pregnancy. Endocrinol Metab Clin North Am 2014; 43 (02) 573-597
    CrossrefPubMedGoogle Scholar
  • 6 Saki F, Dabbaghmanesh MH, Ghaemi SZ, Forouhari S, Ranjbar Omrani G, Bakhshayeshkaram M. Thyroid function in pregnancy and its influences on maternal and fetal outcomes. Int J Endocrinol Metab 2014; 12 (04) e19378
    PubMedGoogle Scholar
  • 7 Stagnaro-Green A, Abalovich M, Alexander E. , et al; American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011; 21 (10) 1081-1125
    CrossrefPubMedGoogle Scholar
  • 8 Abalovich M, Gutierrez S, Alcaraz G, Maccallini G, Garcia A, Levalle O. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid 2002; 12 (01) 63-68
    CrossrefPubMedGoogle Scholar
  • 9 Reid SM, Middleton P, Cossich MC, Crowther CA, Bain E. Interventions for clinical and subclinical hypothyroidism pre-pregnancy and during pregnancy. Cochrane Database Syst Rev 2013; 5 (05) CD007752
    PubMedGoogle Scholar
  • 10 Stagnaro-Green A. Maternal thyroid disease and preterm delivery. J Clin Endocrinol Metab 2009; 94 (01) 21-25
    CrossrefPubMedGoogle Scholar
  • 11 Teng W, Shan Z, Patil-Sisodia K, Cooper DS. Hypothyroidism in pregnancy. Lancet Diabetes Endocrinol 2013; 1 (03) 228-237
    CrossrefPubMedGoogle Scholar
  • 12 Committee on Practice Bulletins—Obstetrics; Society for Maternal–Fetal Medicine. Practice Bulletin No. 169: multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol 2016; 128 (04) e131-e146
    CrossrefPubMedGoogle Scholar
  • 13 Ashoor G, Muto O, Poon LC, Muhaisen M, Nicolaides KH. Maternal thyroid function at gestational weeks 11-13 in twin pregnancies. Thyroid 2013; 23 (09) 1165-1171
    CrossrefPubMedGoogle Scholar
  • 14 Dashe JS, Casey BM, Wells CE. , et al. Thyroid-stimulating hormone in singleton and twin pregnancy: importance of gestational age-specific reference ranges. Obstet Gynecol 2005; 106 (04) 753-757
    CrossrefPubMedGoogle Scholar
  • 15 Casey BM, Thom EA, Peaceman AM. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy. N Engl J Med 2017; 376 (09) 815-825
    CrossrefPubMedGoogle Scholar
  • 16 Alexander EK, Marqusee E, Lawrence J, Jarolim P, Fischer GA, Larsen PR. Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. N Engl J Med 2004; 351 (03) 241-249
    CrossrefPubMedGoogle Scholar