woensdag 18 september 2013

Hypothyroxinemia and TPO-antibody positivity are risk factors for premature delivery: the Generation R study

Premature delivery is an important risk factor for child mortality and psychiatric, metabolic and cardiovascular disease later in life. In the majority of cases, the cause of prematurity cannot be identified. Currently, it remains controversial if an abnormal maternal thyroid function during pregnancy increases the risk of a premature delivery. Therefore, we investigated the relation between maternal serum thyroid parameters and the risk of premature delivery in a large prospective population-based study.

Hypothyroxinemia and TPO-antibody positivity are risk factors for premature delivery:
the Generation R study

TIM Korevaar, S Schalekamp-Timmermans, YB de Rijke, WE Visser, W Visser, SMPF de Muinck Keizer-Schrama, A Hofman, HA Ross, H Hooijkaas, H Tiemeier, JJ Bongers-Schokking, VWV Jaddoe, TJ Visser, EAP Steegers, M Medici en RP Peeters

Design

Serum TSH, FT4, T4 and TPO-antibodies (TPOAb) were determined during early pregnancy in 5971 pregnant women from the Generation R study. Data were available on maternal age, parity, smoking, socio-economic status, ethnicity, maternal anthropometrics and urinary iodine levels.

Tim Korevaar presenteerde dit onderzoek op het ETA schildkliercongres in Leiden, 
zie Abstracts, Oral Presentation 9 (OP9), pagina 78

Results

  • Of all women, 5.0% had a premature delivery (before 37 weeks), 4.4% had a spontaneous premature delivery and 1.4% a very premature delivery (before 34 weeks).
  • High TSH levels and subclinical hypothyroidism were associated with premature delivery but not with spontaneous premature delivery.
  • Maternal hypothyroxinemia was associated with a 2.5-fold increased risk of premature delivery, a 3.4-fold increased risk of spontaneous premature delivery and a 3.6-fold increased risk of very premature delivery.
  • TPOAb positivity was associated with a 1.7-fold increased risk of premature delivery, a 2.1-fold increased risk of spontaneous premature delivery and a 2.5-fold increased risk of very premature delivery.
  • These effects remained similar after correction for TSH/FT4 levels.

Conclusions

Hypothyroxinemia and TPOAb positivity are associated with an increased risk of premature delivery. The increased risk in TPOAb positive women seems to be independent of thyroid function.

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