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8132019 IJE2013-987843

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Hindawi Publishing CorporationInternational Journal o Endocrinology Volume 983090983088983089983091 Article ID 983097983096983095983096983092983091 983094 pageshttpdxdoiorg983089983088983089983089983093983093983090983088983089983091983097983096983095983096983092983091

Clinical Study Maternal Thyroid Dysfunction and Neonatal Thyroid Problems

Hulya Ozdemir1 Ipek Akman1 Senay Coskun1 Utku Demirel2 Serap Turan3

Abdullah Bereket3 Hulya Bilgen1 and Eren Ozek 1

983089 Department of Pediatrics Division of Neonatology Marmara University School of Medicine Istanbul urkey 983090 Yakacik Maternity and Children State Hospital Istanbul urkey 983091 Department of Pediatrics Division of Endocrinology Marmara University School of Medicine Istanbul urkey

Correspondence should be addressed to Ipek Akman ipekakmanyahoocom

Received 983096 May 983090983088983089983090 Accepted 983091 April 983090983088983089983091

Academic Editor Stephen L Atkin

Copyright copy 983090983088983089983091 Hulya Ozdemir et al Tis is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Aim o investigate obstetric eatures o pregnant women with thyroid disorders and thyroid unction tests o their newborn inants Methods Women with hypothyroidism and having anti-thyroglobulin (AG) and anti-thyroid peroxidase (anti-PO) antibodieswere assigned as group I women with hypothyroidism who did not have autoantibodies were assigned as group II and womenwithout thyroid problems were assigned as group III Results Pregnant women with autoimmune hypothyroidism (group I) hadmore preterm delivery andtheir babiesneeded more requent neonatal intensivecare unit (NICU) admission In group I one inantwas diagnosedwith compensated hypothyroidism and oneinant had transient hyperthyrotropinemia Fiveinants(983090983091983096) in group

II had thyroid-stimulating hormone (SH) levels gt983090983088 mIUmL Only two o them had SH level gt983095 mIUL at the 983091rd postnatalweek and all had normal ree 983092 (F983092) Median maternal SH level o these 1047297ve inants with SH gt983090983088 mIUmL was 983094983094 mIUmLIn group III six inants (983094983093) had SH levels above gt983090983088 mIUmL at the 983089st postnatal week Conclusion Inants o mothers withthyroid problems are more likely to have elevated SH and higher recall rate on neonatal thyroid screening Women with thyroiddisorders and their newborn inants should be ollowed closely or both obstetrical problems and or thyroid dysunction

1 Introduction

Hypothyroidism both overt and subclinical is common inwomen o reproductive age and during pregnancy withrequencies ranging rom 983088983091 to 983090983093 [983089] Hypothyroidismhas adverse effects on the course o pregnancy and devel-opment o the etus [983090] Several studies have reported that

maternal hypothyroidism is associated with increased riskso abortions stillbirths preterm delivery and pregnancy-induced hypertension [983091ndash983094] Conversely other reports haveshown successul pregnancy outcomes in women who wereprooundly hypothyroid [983089] More recently the potentialadverse impact o maternal hypothyroidism and hypothyrox-inemia even when subclinical on neurodevelopmental out-comes in the offspring has been recognized [983095ndash983097] Hypothy-roidism should be corrected beore initiation o pregnancyreplacement dosage should be augmented early in pregnancyand euthyroidism should be maintained throughout [983089983088]Maternal hyperthyroidism during pregnancy is associatedwith an increased risk o low birth weight predisposing to

neonatal morbidity and mortality [983089983089] In addition Mediciet al [983089983090] have reported that maternal high-normal F983092 levelsin early pregnancy are associated with lower birth weightand an increased risk o small or gestational age (SGA)newborns

Tyroid-stimulating hormone surges soon afer birthresulting in thyroxine (983092) concentrations that are higher

in the 1047297rst postnatal week than at any other time o lieand in circulating triiodothyronine (983091) concentrations thatare three to our times higher than etus Tyroid hormonesynthesis is critically dependent on an adequate prenataland postnatal supply o iodine which can paradoxically suppress 983092 secretion when present in excess especially inpreterm inants and in the presence o iodine de1047297ciency [983089983091] Congenital hypothyroidism is the most requent causeo preventable mental retardation Neonatal hypothyroidismhas an incidence o one in 983091983088983088983088ndash983092983088983088983088 births and includesboth permanent and transient types [983089983092] Primary congenitalhypothyroidism consists o disorders o thyroid developmentor o thyroid hormone synthesis [983089983093ndash983089983095] ransient congenital

8132019 IJE2013-987843


983090 International Journal o Endocrinology

983137983138983148983141 983089 Demographic and laboratory characteristics o patients

Group I ( = 13) Group II ( = 21) Group III ( = 92) 1038389

Maternal age (median minndashmax) 983091983089 (983090983093ndash983091983097) 983090983097983093 (983090983097ndash983091983097) 983091983089 (983090983097ndash983092983092) 983088983094

Parity (primiparmultipar) 983091983089983088 983095983089983092 983091983095983093983093 983088983092

Previous abortus history () 983092 (983090983094983095) 983089 (983092983093) 983089983089 (983089983090) 983088983090

Previous preterm birth () 983091 (983090983088) 983088 983088 lowast

Current preterm delivery () 983097 (983094983088) 983094 (983090983095983091) 983089983095 (983089983096983093) 983088983088983088983090

Multiple pregnancy () 983092 (983090983094983095) 983090 (983097983089) 983089983091 (983089983092983089) 983088983091

Maternal SHlowastlowast (median minndashmax) 983093 (983088983097ndash983089983092) 983090983095 (983088983090ndash983089983096983097) 983089983096 (983089983089ndash983091983089) lt983088983088983088983089

Maternal F983092lowastlowast (median minndashmax) 983089983089 (983088983095ndash983089983095) 983088983097 (983088983089ndash983089983094) 983089983090 (983089ndash983089983095) lt983088983088983088983089

Birth weight (gram) (median minndashmax) 983090983096983092983088 (983097983095983088ndash983091983094983088983088) 983091983089983096983088 (983089983095983088983088ndash983092983090983091983088) 983091983089983092983088 (983089983090983088983088ndash983092983093983093983088) 983088983091

Gestational age (week) (median minndashmax) 983091983094983093 (983090983097ndash983091983096) 983091983096 (983091983090ndash983092983088) 983091983096 (983090983097983093ndash983092983089) 983088983088983088983090

Sex (emalemale) () 983091983091983091983094983094983095 983092983088983097983093983097983089 983093983092983091983092983093983094 983088983089

Intrauterine growth retardation () 983090 (983089983093983092) 983089 (983092983096) 983096 (983096983096) 983088983094

NICU admission () 983094 (983092983094983095) 983096 (983091983089983096) 983091 (983091983091) lt983088983088983088983089lowastStatistical analysis inapplicablelowastlowastMeasurements were obtained at 983091rd trimester

hypothyroidism can be due to iodine de1047297ciency or excessmaternal consumption o goitrogens or antithyroid med-ications during pregnancy transplacental passage o SHreceptor-blocking antibodies and neonatal very low birthweight and prematurity [983089983094] Even transient hypothyroidismcan cause adverse neurologic outcome in a newborn Tusearly diagnosis and treatment is recommended

Te aim o this study is to investigate obstetric eatures o pregnantwomen with thyroid disordersand postnatal clinicalcourse and thyroid unction tests o their newborn inants

2 MethodsTe study group consisted o the pregnant women withthyroid disorders ollowed in the obstetric outpatient clinicat Marmara Unıversity Hospital in urkey in 983090983088983088983096ndash983090983088983089983088 Tecontrol group wascomposed o healthy pregnant women whopresented to the obstetric outpatient clinic on the same day o the enrollment o a hypothyroid patient Tree controlmothers were enrolled or each mother with thyroid disorderTe de1047297nition o maternal hypothyroidism was based onthe diagnosis o an endocrinologist and thyroid hormonereplacement was done throughoutpregnancy Duringclinicalollowup thyroid unction tests including F983092 and SHand thyroid autoantibody titers (anti-PO and AG) were

measured Te obstetric and clinical eatures o patients werereviewed Hypothyroid women with positive AG and anti-PO titers were assigned as group I ( = 13) and those whodid not have autoantibodies were assigned as group II ( =21) while women without thyroid problems were assigned asgroup III ( = 92) Demographic characteristics o the inantswere recorded Tyroid tests o the inants were measuredin the 1047297rst postnatal week and third postnatal week in thestudy group Tyroid unction test o the inants o controlgroup was checked beore discharge rom the hospital SerumSH F983092 anti-PO and AG was measured by chemilumi-nescence assay (Roche Switzerland) Newborns with serumSH ge983090983088 mIUL were considered abnormal at 1047297rst postnatal

week and were recalled or urther evaluation On the 983091rdweek i SH gt983095 mIUL and F983092 lt983089 ngdL the inant wasconsidered to have congenital hypothyroidism and thosewith high SH at the 1047297rst week but normal serum SH and983092 values at the third week were considered to have transienthyperthyrotropinemia (H) AG gt983089983088983088 IUmL and anti-PO gt983091983088 IUmL were considered to be abnormal

Inormed consent was obtained rom all patients and thestudy was approved by institutional review board

983090983089 Statistical Analysis Mann-Whitney U and Kruskal-Wallistests were used or quantitative variables and Fischerrsquos exact

test was used or categorical variables Correlation betweenneonatal and mother anti-PO and AG was assessed by Spearmanrsquos rank correlation test 1038389 lt 005 was consideredsigni1047297cant SPSS 983089983095983088 was used or statistical analysis

3 Results

Demographic characteristics o the patients were given inable 983089 Maternal age parity and previous abortus history were not signi1047297cantly different among the groups Howeverpregnant women with autoimmune hypothyroidism (groupI) had more preterm delivery and their babies needed morerequent NICU admission NICU admission diagnoses were

mainly respiratory distress or suspected sepsis Rates orgestational diabetes mellitus (983090983089983094) and pregnancy-inducedhypertension (983089983092983093) tended to be higher in mothers withthyroid problem (groups I-II) compared to the control group(983089983096 and 983090983089 resp) reatment or inertility was requiredin983091983096( = 5)omothersingroupI983097983093( = 2)ingroupII983091983090 ( = 3) in group III However due to inadequate samplesize statistical analysis was not possible

Six inants in group I (983092983088) had positive anti-POtiters at the end o the 983089st postnatal week all except onehad undetectable titers at the end o the 983091rd week Meanmaternal PO titers were signi1047297cantly higher in inants withpositive PO titers compared to inants with negative titers

8132019 IJE2013-987843


International Journal o Endocrinology 983091

(3626 plusmn 115 IUmL versus 478 plusmn 74 IUmL 1038389 = 0001 1103925 =983088983095983093983094) en mothers had high AG titers whereas none o their inants had high AG titers In group I one inantwas diagnosed with compensated hypothyroidism Tyroidhormone replacement was prescribed but not given to theinant by the parents In the ollowup thyroid unctions tests

were entirely normal at the 983096th postnatal weekFive inants (983090983091983096) in group II had SH levelsgt983090983088 mIUmL Only two o them had SH level gt983095 mIULat the 983091rd postnatal week During ollowup all SH valuesreturned to normal rangesat the 983096th postnatal week (able 983090)Median maternal SH level o these 1047297ve inants with SHgt983090983088 mIUmL was 983094983094 mIUmL In group III six inants(983094983093) had SH levels above gt983090983088 mIUmL at the 983089st postnatalweek but SH levels returned to normal at the 983091rd week inall None o the patients required treatment in group III Teresults indicated a higher neonatal SH recall rate in inantso mother with thyroid problems (1038389 = 002) Te comparisono maternal SH and F983092 levels at 983091rd trimester revealedstatistically signi1047297cant difference between groups indicatinginadequately controlled patients among groups I and II(able 983089)

4 Discussion

In this study we ound that pregnant women with autoim-mune hypothyroidism had more preterm delivery and theirbabies needed more requent NICU admission Te inantso hypothyroid mothers had higher recall rate in newbornSH screening and transient thyroid dysunction in the 1047297rst983096 weeks o lie

Tyroid disease is common in women o reproductiveage Te requency o thyroid de1047297ciency varies among preg-nant women in different countries and ranges between 983088983089983097in Japan and as high as 983090983090 in Belgium and 983090983093 in theUnited States [983089983096ndash983090983088] Maternal thyroid de1047297ciency even sub-clinical has been reported to be associatedwith adverse preg-nancy outcomes that maybe improvedby 983092 replacement [983092]Fluctuations that occur in 983092 metabolism during pregnancy make it difficult to maintain meticulous normal thyroidhormone values during gestation in hypothyroid mothers[983090983089] Pregnancy causes increased thyroid gland vascularityincreased renal iodide clearance and iodide losses to theoetus [983089] Prenatal vitamin supplements commonly takenduring pregnancy are rich in iron and calcium both o whichinhibit thyroxine absorption [983090983090 983090983091] Many prenatal vitamins

do not contain the recommended 983090983088983088 907317g o iodine orpregnancy [983090983092] Fluctuations in thyroxine metabolism thatoccur during pregnancy may urther impair maternal-oetaltranser o thyroxine despite apparently optimal maternalthyroid status [983090983093] Reduced oetal thyroxine may causedisruption to the development o the pituitary-thyroid axis o the newborn oetal pituitary GH secretion vascular respon-siveness and maturation and cardiovascular homeostasisin utero [983090983093ndash983090983095] Tese actors may be responsible or theobservation o a reduced neonatal birthweight o offspringborn to mothers with inadequately controlled thyroid statusat initial presentation and at the third trimester Pregnantwomen who at 1047297rst presentation had above 983097983096 percentile o

SH levels or those whose SH remained suboptimal in the1047297nal trimester o pregnancy may be more likely to give birthto a low-birthweight inant [983089]

Several studies have reported that maternal hypothy-roidism is associated with increased risks o abortionsstillbirths preterm delivery and pregnancy-induced hyper-

tension [983091ndash983094] Autoimmune thyroid disease is common inpregnancy Subclinical hypothyroidism has been associatedwith miscarriage in both 1047297rst and second trimesters [983090983096]Similarly the presence o antibodies to thyroid peroxidaseor thyroglobulin is associated with a signi1047297cant increment inmiscarriages [983090] In our study 983090983094983095 o mothers in group Ihad a previous abortus history but probably due to inade-quate sample size this is not signi1047297cantly different than thecontrol group Glinoer et al [983090983097] documented an increasedrate o preterm birth in 983096983095 women with autoimmune thyroiddisease In our study preterm birth rate was increasedin group I as well Rates or gestational diabetes mellituspregnancy-induced hypertension and treatment o inertility tendedto be higher in mothers withboth autoimmune (groupI) and nonautoimmune thyroid diseases (group II) comparedto the control group However due to inadequate sample sizestatistical analysis was not possible

Autoimmune thyroid disease inpregnancy possessesimportant risk actors both or the mother the etus andnewborn inant Te clinical and endocrinological pictures o the thyroid disease in pregnant women and their offspringscan vary greatly and mainly depend on the type and amounto the anti-thyroid autoantibodies which cross the placenta[983091983088] Te reported prevalence o thyroid autoantibodies inpregnant women ranges rom 983093983090 in Belgium to 983089983090983093 inNorth America Although a uniorm correlation betweenmaternal or newborn serum thyroid autoantibodies andsporadic congenital hypothyroidism is lacking there aremany reports relating maternal autoimmune thyroid dis-ease to transient congenital hypothyroidism in newbornthyroid screening programs [983091983089ndash983091983091] Dussault and Fisher[983091983092] documented that elevated SH concentrations weremore requent (983095983088 versus 983088983097 1038389 lt 0001) in themothers o hypothyroid newborns Tey also documentedthat the prevalence o newborn transient hypothyroidismwas signi1047297cantly higher (983090983095 versus 983089983093 1038389 = 004) in themothers with autoimmune thyroid disease Korkmaz et al[983091983093] demonstrated that none o the newborn inants withmaternal Hashimato disease in the early neonatal periodhad abnormal thyroid unction tests or physical examination

1047297ndings In our study six inants in group I (983092983088) hadpositive anti-PO titers at the end o the 1047297rst postnatalweek all except one who had undetectable titers at theend o the third week Mean maternal anti-PO titers weresigni1047297cantly higher in inants with positive titers comparedto inants with negative titers None o the inants o motherswith elevated Anti-G antibodies had elevated serum anti-G levels Tese results suggest that maternal PO levelsespecially the high titers are transerred to the inant and areclinically more relevant In group I one inant was diagnosedwith compensated hypothyroidism In our study the resultsindicated a higher recall rate in newborn screening in inantso mother with thyroid problems although most o them

8132019 IJE2013-987843



T 983137 983138 983148 983141 983090 N e o n a t a

l t h y r o i d d i s f u n c t i o n i n t h e s t u d y g r o u p

P a t i e n t

n o

G r o u p

G e s t a t i o n a l

a g e ( w e e k )

M a t e r n a l

T S H l e

v e l

( m I U m

L ) lowast

M a t e r n a l

F T 983092 l e v e l

( m I U m L ) lowast

T r e a t m e n t

o f t h e

m o t h e r

T S H l e

v e l

( m I U m

L )

983089 s t w e e k

F T 983092 l e v e l

( n g d L )

983089 s t w e e k

T S H l e v e l

( m I U m L )

983091 r d w e e k

F T 983092 l e v e l s

( n g d L )

983091 r d w e e k

T S H l e v e l

( m I U m L )

983096 t h w e e k

F T 983092 l e v e l s

( n g d L )

983096 t h w e e k

D i a g n o s

i s

T r e a t m e n t

983089

I

983091 983096

983093 983094

983089 983089

L - t h y r o x i n e

983094 983091

983089 983093 983093

983095 983092 983092

983089 983090

983089 983092

983089 983091

T r a n s i e n t

h y p e r t h y r o t r o p i n e m i a

( minus )

983090

I

983091 983094

983093 983095

983089 983095


983089 983088 983095

983089 983090

983089 983092 983092

983089 983088 983094

983092 983090

983089 983093

T r a n s i e n t

c o m p e n s a

t e d

h y p o t h y r o i

d i s m

( + )

983091

I I

983092 983088

983095 983090

983089 983095


983091 983088 983095

983089 983097

983089 983090 983092

983090 983090

983091 983090

983089 983095

T r a n s i e n t


( minus )

983092

I I

983091 983092

983088 983097

983089 983094


983090 983089 983096

983090 983095

983091 983091

983089 983092

mdash

mdash

T r a n s i e n t


( minus )

983093

I I

983091 983094

983089 983094

983088 983096


983090 983089 983095

983089 983097

983092 983092

983089 983094

mdash

mdash

T r a n s i e n t


( minus )

983094

I I

983091 983096

983093 983091

983089 983090


983090 983097 983095

983090 983090

983097 983097

983089 983094

983093 983096

983089 983090

T r a n s i e n t


( minus )

983095

I I

983091 983095

983091 983090

983088 983095


983090 983088 983097

983090 983089

983093 983090

983089 983091

mdash

mdash

T r a n s i e n t


( minus )

lowast

I f T S H gt

983095 m I U m L a t t h e t h i r d w e e k

T S H

l e v e l i s r e c h e c k e d e v e r y t w o w e e k s u n t i l i t c o m e s d o w n t o n o r m a l v a l u e s

8132019 IJE2013-987843



returned to normal on ollowup Te median SH levels o mothers o the inants with hyperthyrotropinemia were alsohigh indicating inadequate control o thyroid status duringpregnancy In group I the median SH level o motherswas 983093 mIUL which was higher than the recommended goal(983090983093 mIUL) undertreated hypothyroidism might had an

additional negative effect on developing etusWomen with thyroid disorders should be ollowed closely throughout pregnancy or the prevention o obstetric compli-cations and their newborn inants should be ollowed closely in the 1047297rst months o postnatal lie or thyroid dysunction

References

[983089] I Idris R Srinivasan and A Simm ldquoMaternal hypothyroidismin early and late gestation effects on neonatal and obstetricoutcomerdquo Clinical Endocrinology vol 983094983091 no 983093 pp 983093983094983088ndash983093983094983093983090983088983088983093

[983090] M Abalovich N Amino L A Barbour et al ldquoClinical practiceguideline management o thyroid dysunction during preg-nancy and postpartum an endocrine society clinical practiceguidelinerdquo Journal of Clinical Endocrinology and Metabolism vol 983097983090 supplement 983096 pp S983089ndashS983092983095 983090983088983088983095

[983091] M N Montoro ldquoManagement o hypothyroidism during preg-nancyrdquo Clinical Obstetrics and Gynecology vol983092983088 no 983089pp 983094983093ndash983096983088 983089983097983097983095

[983092] L E Davis K J Leveno and E G Cunningham ldquoHypothy-roidism complicating pregnancyrdquo Obstetrics amp Gynecology vol983095983090 no 983089 pp 983089983088983096ndash983089983089983090 983089983097983096983096

[983093] R C Smallridge and P W Ladenson ldquoHypothyroidism inpregnancy consequences to neonatal healthrdquo Te Journal of Clinical Endocrinology and Metabolism vol983096983094 no 983094pp 983090983091983092983097ndash983090983091983093983091 983090983088983088983089

[983094] N Wasserstrum and C A Anania ldquoPerinatal consequences o maternal hypothyroidism in early pregnancy and inadequatereplacementrdquo Clinical Endocrinology vol 983092983090 no 983092pp983091983093983091ndash983091983093983096983089983097983097983093

[983095] J E Haddow G E Palomaki W C Allan et al ldquoMaternalthyroid de1047297ciency during pregnancy andd subssequent neu-roppsychological development o the childrdquo Te New England Journal of Medicine vol 983091983092983089 no 983096 pp 983093983092983097ndash983093983093983093 983089983097983097983097

[983096] R Z Klein and M L Mitchell ldquoMaternal hypothyroidism andchild developmentrdquo Hormone Research vol 983093983090 no 983090 pp 983093983093ndash983093983097983089983097983097983097

[983097] V J Pop E P Brouwers H L Vader Vulsma A L van Baarand J J de Vijlder ldquoMaternal hypothyroxinaemia during early pregnancy and subsequent child development a 983091-year ollow-up studyrdquo Clinical Endocrinology vol 983093983097 no 983091 pp 983090983096983090ndash983090983096983096983090983088983088983091

[983089983088] E K Alexander E Marqusee J Lawrence P Jarolim G AFischer andPR Larsen ldquoiming and magnitudeo increasesinlevothyroxine requirements during pregnancy in women withhypothyroidismrdquo Te New England Journal of Medicine vol 983091983093983089no 983091 pp 983090983092983089ndash983091983092983097 983090983088983088983092

[983089983089] M Medici S immermans W Visser et al ldquoMaternal thyroidhormone parameters during early pregnancy and birth weightthe Generation R studyrdquo Te Journal of Clinical Endocrinology and Metabolism vol 983097983096 no 983091 pp 983093983097ndash983094983094 983090983088983089983091

[983089983090] M Medici Y B de Rijke R P Peeters et al ldquoMaternal early pregnancy and newborn thyroid hormone parameters the

Generation R studyrdquo Te Journal of Clinical Endocrinology and Metabolism vol 983097983095 no 983090 pp 983094983092983094ndash983094983093983090 983090983088983089983090

[983089983091] S B Feingold and R S Brown ldquoNeonatal thyroid unctionrdquoNeoReviews vol 983089983089 no 983089983089 pp e983094983092983088ndashe983094983092983094 983090983088983089983088

[983089983092] S Benvenga A Ordookhani E N Pearce M onacchera FAzizi and L E Braverman ldquoDetection o circulating autoanti-

bodies against thyroid hormones in an inant with permanentcongenital hypothyroidism and her twin with transient congen-ital hypothyroidism possible contribution o thyroid hormoneautoantibodies to neonatal and inant hypothyroidismrdquo Te Journal of Pediatric Endocrinology and Metabolism vol 983090983089 no983089983088 pp 983089983088983089983089ndash983089983088983090983088 983090983088983088983096

[983089983093] S Reetoff J Dumont and G Vassart ldquoTyroid disordersrdquo inTe Metabolic and Molecular Bases of Inherited Diseases C RScriver A L Beaudet W S Sly et al Eds pp 983092983088983090983097ndash983092983088983095983093McGraw-Hill New York NY USA 983096th edition 983090983088983088983089

[983089983094] M H MacGillivray ldquoCongenital hypothyroidismrdquo in PediatricEndocrinology Mechanisms Manifestations and Management O H Pescovitz and E A Eugster Eds pp 983092983097983088ndash983093983088983095 LippincottWilliams and Wilkins Philadelphia Pa USA 983089st edition 983090983088983088983092

[983089983095] M de Felice and R di Lauro ldquoTyroid development andits disorders genetics and molecular mechanismsrdquo EndocrineReviews vol 983090983093 no 983093 pp 983095983090983090ndash983095983092983094 983090983088983088983092

[983089983096] K Kamijo Saito M Sato et al ldquoransient subclinical hypo-thyroidism in early pregnancyrdquo Endocrinologia Japonica vol 983091983095no 983091 pp 983091983097983095ndash983092983088983091 983089983097983097983088

[983089983097] D Glinoer ldquoTe regulation o thyroid unction in pregnancypathways o endocrine adaptation rom physiology to pathol-ogyrdquo Endocrine Reviews vol 983089983096 no 983091 pp 983092983088983092ndash983092983091983091 983089983097983097983095

[983090983088] R D Ultiger ldquoMaternal hypothyroidism and etal develop-mentrdquo Te New England Journal of Medicine vol 983091983092983089 no 983096 pp983094983088983089ndash983094983088983090 983089983097983097983097

[983090983089] G A Brent ldquoMaternal hypothyroidism recognition and man-

agementrdquo Tyroid vol 983097 no 983095 pp 983094983094983089ndash983094983094983093 983089983097983097983097[983090983090] N R Campbell B B Hasinoff H Stalts B Rao and N C

Wong ldquoFerrous sulphate reduces thyroxine efficiacy in patientswith hypothyroidismrdquo Annals of Internal Medicine vol 983089983089983095 no983089983090 pp 983089983088983089983088ndash983089983088983089983091 983089983097983097983090

[983090983091] N Singh P N Singh and J M Hershman ldquoEffect o calciumcarbonate on the absorption o levothyroxinerdquo TeJournalof the American Medical Association vol 983090983096983091 no 983090983089 pp 983090983096983090983090ndash983090983096983090983093983090983088983088983088

[983090983092] A M Leung E N Pearce and L E Braverman ldquoIodinecontento prenatal multivitamins in the UnitedStatesrdquo Te NewEngland Journal of Medicine vol 983091983094983088 no 983097 pp 983097983091983097ndash983097983092983088 983090983088983088983097

[983090983093] S BlazerY Moreh-Waterman R Miller-Lotan A amir and ZHochberg ldquoMaternal hypothyroidism may affect etal growthand neonatal thyroid unctionrdquo Obstetrics amp Gynecology vol983089983088983090 no 983090 pp 983090983091983090ndash983090983092983089 983090983088983088983091

[983090983094] B Bonet and E Herrera ldquoDifferent response to maternalhypothyroidism during the 1047297rst and second hal o gestation inthe ratrdquo Endocrinology vol 983089983090983090 no 983090 pp 983092983093983088ndash983092983093983093 983089983097983096983096

[983090983095] S Q Le N Wasserstrum J V Mombouli and P M VanhoutteldquoContractile effect o endothelin in human placental veins roleo endothelium prostaglandins and thromboxanerdquo American Journal of Obstetrics and Gynecology vol 983089983094983097 no 983092 pp 983097983089983097ndash983097983090983092983089983097983097983091

[983090983096] A Stagnaro-Green ldquoMaternal thyroid disease and pretermdeliveryrdquo Te Journal of Clinical Endocrinology and Metabolism vol 983097983092 no 983089 pp 983090983089ndash983090983093 983090983088983088983097

8132019 IJE2013-987843



[983090983097] D Glinoer M Riahi J P Grun and J Kinthaert ldquoRisk o subclinical hypothyroidism in pregnant women with asymp-tomatic autoimmune thyroid disordersrdquo Te Journal of Clinical Endocrinology and Metabolism vol 983095983097 no 983089 pp 983089983097983095ndash983090983088983092 983089983097983097983092

[983091983088] D A Fisher M R Pandian and E Carlton ldquoAutoimmunethyroid disease an expanding spectrumrdquo Pediatric Clinics of North America vol 983091983092 no 983092 pp 983097983088983095ndash983097983089983096 983089983097983096983095

[983091983089] J H Dussault J Letarte H Guyda and C Laberge ldquoLack o in1047298uence o thyroid antibodies on thyroid unction in thenewborninant and on a massscreening programor congenitalhypothyroidismrdquo Journal of Pediatrics vol 983097983094 no 983091 I pp 983091983096983093ndash983091983096983097 983089983097983096983088

[983091983090] N Matsuura Y Yamada and Y Nohara ldquoFamilial neona-tal transient hypothyroidism due to maternal SH-bindinginhibitor immunoglobulinsrdquo Te New England Journal of Medicine vol 983091983088983091 no 983089983091 pp 983095983091983096ndash983095983092983089 983089983097983096983088

[983091983091] R S Brown R L Bellisario D Botero et al ldquoIncidence o tran-sient congenital hypothyroidism due to maternal thyrotropinreceptor-blocking antibodies in over one million babiesrdquo Te Journal of Clinical Endocrinology and Metabolism vol 983096983089 no 983091

pp 983089983089983092983095ndash983089983089983093983089 983089983097983097983094[983091983092] J H Dussault andD A Fisher ldquoTyroid unction in mothers o

hypothyroid newbornsrdquo Obstetrics amp Gynecology vol 983097983091 no 983089pp 983089983093ndash983090983088 983089983097983097983097

[983091983093] A Korkmaz E F Canpolat M Yurdak ok S Yigit and Gekinalp ldquoHashimato hastalıgı olan annelerin bebeklerininincelenmesi retrospekti calısmardquo Cocuk Sa˘ glı˘ gı ve HastalıklarıDergisi vol 983092983096 no 983089 pp 983090983088ndash983090983092 983090983088983088983093

8132019 IJE2013-987843



983137983138983148983141 983089 Demographic and laboratory characteristics o patients

Group I ( = 13) Group II ( = 21) Group III ( = 92) 1038389

Maternal age (median minndashmax) 983091983089 (983090983093ndash983091983097) 983090983097983093 (983090983097ndash983091983097) 983091983089 (983090983097ndash983092983092) 983088983094

Parity (primiparmultipar) 983091983089983088 983095983089983092 983091983095983093983093 983088983092

Previous abortus history () 983092 (983090983094983095) 983089 (983092983093) 983089983089 (983089983090) 983088983090

Previous preterm birth () 983091 (983090983088) 983088 983088 lowast

Current preterm delivery () 983097 (983094983088) 983094 (983090983095983091) 983089983095 (983089983096983093) 983088983088983088983090

Multiple pregnancy () 983092 (983090983094983095) 983090 (983097983089) 983089983091 (983089983092983089) 983088983091

Maternal SHlowastlowast (median minndashmax) 983093 (983088983097ndash983089983092) 983090983095 (983088983090ndash983089983096983097) 983089983096 (983089983089ndash983091983089) lt983088983088983088983089

Maternal F983092lowastlowast (median minndashmax) 983089983089 (983088983095ndash983089983095) 983088983097 (983088983089ndash983089983094) 983089983090 (983089ndash983089983095) lt983088983088983088983089

Birth weight (gram) (median minndashmax) 983090983096983092983088 (983097983095983088ndash983091983094983088983088) 983091983089983096983088 (983089983095983088983088ndash983092983090983091983088) 983091983089983092983088 (983089983090983088983088ndash983092983093983093983088) 983088983091

Gestational age (week) (median minndashmax) 983091983094983093 (983090983097ndash983091983096) 983091983096 (983091983090ndash983092983088) 983091983096 (983090983097983093ndash983092983089) 983088983088983088983090

Sex (emalemale) () 983091983091983091983094983094983095 983092983088983097983093983097983089 983093983092983091983092983093983094 983088983089

Intrauterine growth retardation () 983090 (983089983093983092) 983089 (983092983096) 983096 (983096983096) 983088983094

NICU admission () 983094 (983092983094983095) 983096 (983091983089983096) 983091 (983091983091) lt983088983088983088983089lowastStatistical analysis inapplicablelowastlowastMeasurements were obtained at 983091rd trimester

hypothyroidism can be due to iodine de1047297ciency or excessmaternal consumption o goitrogens or antithyroid med-ications during pregnancy transplacental passage o SHreceptor-blocking antibodies and neonatal very low birthweight and prematurity [983089983094] Even transient hypothyroidismcan cause adverse neurologic outcome in a newborn Tusearly diagnosis and treatment is recommended

Te aim o this study is to investigate obstetric eatures o pregnantwomen with thyroid disordersand postnatal clinicalcourse and thyroid unction tests o their newborn inants

2 MethodsTe study group consisted o the pregnant women withthyroid disorders ollowed in the obstetric outpatient clinicat Marmara Unıversity Hospital in urkey in 983090983088983088983096ndash983090983088983089983088 Tecontrol group wascomposed o healthy pregnant women whopresented to the obstetric outpatient clinic on the same day o the enrollment o a hypothyroid patient Tree controlmothers were enrolled or each mother with thyroid disorderTe de1047297nition o maternal hypothyroidism was based onthe diagnosis o an endocrinologist and thyroid hormonereplacement was done throughoutpregnancy Duringclinicalollowup thyroid unction tests including F983092 and SHand thyroid autoantibody titers (anti-PO and AG) were

measured Te obstetric and clinical eatures o patients werereviewed Hypothyroid women with positive AG and anti-PO titers were assigned as group I ( = 13) and those whodid not have autoantibodies were assigned as group II ( =21) while women without thyroid problems were assigned asgroup III ( = 92) Demographic characteristics o the inantswere recorded Tyroid tests o the inants were measuredin the 1047297rst postnatal week and third postnatal week in thestudy group Tyroid unction test o the inants o controlgroup was checked beore discharge rom the hospital SerumSH F983092 anti-PO and AG was measured by chemilumi-nescence assay (Roche Switzerland) Newborns with serumSH ge983090983088 mIUL were considered abnormal at 1047297rst postnatal

week and were recalled or urther evaluation On the 983091rdweek i SH gt983095 mIUL and F983092 lt983089 ngdL the inant wasconsidered to have congenital hypothyroidism and thosewith high SH at the 1047297rst week but normal serum SH and983092 values at the third week were considered to have transienthyperthyrotropinemia (H) AG gt983089983088983088 IUmL and anti-PO gt983091983088 IUmL were considered to be abnormal

Inormed consent was obtained rom all patients and thestudy was approved by institutional review board

983090983089 Statistical Analysis Mann-Whitney U and Kruskal-Wallistests were used or quantitative variables and Fischerrsquos exact

test was used or categorical variables Correlation betweenneonatal and mother anti-PO and AG was assessed by Spearmanrsquos rank correlation test 1038389 lt 005 was consideredsigni1047297cant SPSS 983089983095983088 was used or statistical analysis

3 Results

Demographic characteristics o the patients were given inable 983089 Maternal age parity and previous abortus history were not signi1047297cantly different among the groups Howeverpregnant women with autoimmune hypothyroidism (groupI) had more preterm delivery and their babies needed morerequent NICU admission NICU admission diagnoses were

mainly respiratory distress or suspected sepsis Rates orgestational diabetes mellitus (983090983089983094) and pregnancy-inducedhypertension (983089983092983093) tended to be higher in mothers withthyroid problem (groups I-II) compared to the control group(983089983096 and 983090983089 resp) reatment or inertility was requiredin983091983096( = 5)omothersingroupI983097983093( = 2)ingroupII983091983090 ( = 3) in group III However due to inadequate samplesize statistical analysis was not possible

Six inants in group I (983092983088) had positive anti-POtiters at the end o the 983089st postnatal week all except onehad undetectable titers at the end o the 983091rd week Meanmaternal PO titers were signi1047297cantly higher in inants withpositive PO titers compared to inants with negative titers

8132019 IJE2013-987843





4 Discussion









8132019 IJE2013-987843



T 983137 983138 983148 983141 983090 N e o n a t a


P a t i e n t

n o

G r o u p


a g e ( w e e k )

M a t e r n a l

T S H l e

v e l

( m I U m

L ) lowast

M a t e r n a l

F T 983092 l e v e l


T r e a t m e n t

o f t h e

m o t h e r

T S H l e

v e l

( m I U m

L )

983089 s t w e e k

F T 983092 l e v e l

( n g d L )

983089 s t w e e k

T S H l e v e l

( m I U m L )

983091 r d w e e k

F T 983092 l e v e l s

( n g d L )

983091 r d w e e k

T S H l e v e l

( m I U m L )

983096 t h w e e k

F T 983092 l e v e l s

( n g d L )

983096 t h w e e k

D i a g n o s

i s

T r e a t m e n t

983089

I

983091 983096

983093 983094

983089 983089


983094 983091

983089 983093 983093

983095 983092 983092

983089 983090

983089 983092

983089 983091

T r a n s i e n t


( minus )

983090

I

983091 983094

983093 983095

983089 983095


983089 983088 983095

983089 983090

983089 983092 983092

983089 983088 983094

983092 983090

983089 983093

T r a n s i e n t

c o m p e n s a

t e d

h y p o t h y r o i

d i s m

( + )

983091

I I

983092 983088

983095 983090

983089 983095


983091 983088 983095

983089 983097

983089 983090 983092

983090 983090

983091 983090

983089 983095

T r a n s i e n t


( minus )

983092

I I

983091 983092

983088 983097

983089 983094


983090 983089 983096

983090 983095

983091 983091

983089 983092

mdash

mdash

T r a n s i e n t


( minus )

983093

I I

983091 983094

983089 983094

983088 983096


983090 983089 983095

983089 983097

983092 983092

983089 983094

mdash

mdash

T r a n s i e n t


( minus )

983094

I I

983091 983096

983093 983091

983089 983090


983090 983097 983095

983090 983090

983097 983097

983089 983094

983093 983096

983089 983090

T r a n s i e n t


( minus )

983095

I I

983091 983095

983091 983090

983088 983095


983090 983088 983097

983090 983089

983093 983090

983089 983091

mdash

mdash

T r a n s i e n t


( minus )

lowast

I f T S H gt


T S H


8132019 IJE2013-987843





References
































8132019 IJE2013-987843











8132019 IJE2013-987843





4 Discussion









8132019 IJE2013-987843



T 983137 983138 983148 983141 983090 N e o n a t a


P a t i e n t

n o

G r o u p


a g e ( w e e k )

M a t e r n a l

T S H l e

v e l

( m I U m

L ) lowast

M a t e r n a l

F T 983092 l e v e l


T r e a t m e n t

o f t h e

m o t h e r

T S H l e

v e l

( m I U m

L )

983089 s t w e e k

F T 983092 l e v e l

( n g d L )

983089 s t w e e k

T S H l e v e l

( m I U m L )

983091 r d w e e k

F T 983092 l e v e l s

( n g d L )

983091 r d w e e k

T S H l e v e l

( m I U m L )

983096 t h w e e k

F T 983092 l e v e l s

( n g d L )

983096 t h w e e k

D i a g n o s

i s

T r e a t m e n t

983089

I

983091 983096

983093 983094

983089 983089


983094 983091

983089 983093 983093

983095 983092 983092

983089 983090

983089 983092

983089 983091

T r a n s i e n t


( minus )

983090

I

983091 983094

983093 983095

983089 983095


983089 983088 983095

983089 983090

983089 983092 983092

983089 983088 983094

983092 983090

983089 983093

T r a n s i e n t

c o m p e n s a

t e d

h y p o t h y r o i

d i s m

( + )

983091

I I

983092 983088

983095 983090

983089 983095


983091 983088 983095

983089 983097

983089 983090 983092

983090 983090

983091 983090

983089 983095

T r a n s i e n t


( minus )

983092

I I

983091 983092

983088 983097

983089 983094


983090 983089 983096

983090 983095

983091 983091

983089 983092

mdash

mdash

T r a n s i e n t


( minus )

983093

I I

983091 983094

983089 983094

983088 983096


983090 983089 983095

983089 983097

983092 983092

983089 983094

mdash

mdash

T r a n s i e n t


( minus )

983094

I I

983091 983096

983093 983091

983089 983090


983090 983097 983095

983090 983090

983097 983097

983089 983094

983093 983096

983089 983090

T r a n s i e n t


( minus )

983095

I I

983091 983095

983091 983090

983088 983095


983090 983088 983097

983090 983089

983093 983090

983089 983091

mdash

mdash

T r a n s i e n t


( minus )

lowast

I f T S H gt


T S H


8132019 IJE2013-987843





References
































8132019 IJE2013-987843











8132019 IJE2013-987843



T 983137 983138 983148 983141 983090 N e o n a t a


P a t i e n t

n o

G r o u p


a g e ( w e e k )

M a t e r n a l

T S H l e

v e l

( m I U m

L ) lowast

M a t e r n a l

F T 983092 l e v e l


T r e a t m e n t

o f t h e

m o t h e r

T S H l e

v e l

( m I U m

L )

983089 s t w e e k

F T 983092 l e v e l

( n g d L )

983089 s t w e e k

T S H l e v e l

( m I U m L )

983091 r d w e e k

F T 983092 l e v e l s

( n g d L )

983091 r d w e e k

T S H l e v e l

( m I U m L )

983096 t h w e e k

F T 983092 l e v e l s

( n g d L )

983096 t h w e e k

D i a g n o s

i s

T r e a t m e n t

983089

I

983091 983096

983093 983094

983089 983089


983094 983091

983089 983093 983093

983095 983092 983092

983089 983090

983089 983092

983089 983091

T r a n s i e n t


( minus )

983090

I

983091 983094

983093 983095

983089 983095


983089 983088 983095

983089 983090

983089 983092 983092

983089 983088 983094

983092 983090

983089 983093

T r a n s i e n t

c o m p e n s a

t e d

h y p o t h y r o i

d i s m

( + )

983091

I I

983092 983088

983095 983090

983089 983095


983091 983088 983095

983089 983097

983089 983090 983092

983090 983090

983091 983090

983089 983095

T r a n s i e n t


( minus )

983092

I I

983091 983092

983088 983097

983089 983094


983090 983089 983096

983090 983095

983091 983091

983089 983092

mdash

mdash

T r a n s i e n t


( minus )

983093

I I

983091 983094

983089 983094

983088 983096


983090 983089 983095

983089 983097

983092 983092

983089 983094

mdash

mdash

T r a n s i e n t


( minus )

983094

I I

983091 983096

983093 983091

983089 983090


983090 983097 983095

983090 983090

983097 983097

983089 983094

983093 983096

983089 983090

T r a n s i e n t


( minus )

983095

I I

983091 983095

983091 983090

983088 983095


983090 983088 983097

983090 983089

983093 983090

983089 983091

mdash

mdash

T r a n s i e n t


( minus )

lowast

I f T S H gt


T S H


8132019 IJE2013-987843





References
































8132019 IJE2013-987843











8132019 IJE2013-987843





References
































8132019 IJE2013-987843











8132019 IJE2013-987843









