maandag 11 april 2016

Subclinical hypothyroidism, thyroid autoimmunity and pregnancy loss or live birth

Voorafgaande studies (onder andere dat van Vissenberg e.a.) naar mogelijke gevolgen van subklinische hypothyreoïdie (SCH) en TPO-antistoffen voor vruchtbaarheid en zwangerschap gaven gemengde resultaten. De tijd om zwanger (TTP) te raken was niet onderzocht in deze patiëntenpopulatie. Reden voor nader onderzoek door Plowden en anderen.

Subclinical hypothyroidism and thyroid autoimmunity are not associated with fecundity, pregnancy loss or live birth
TC Plowden, EF Schisterman, LA Sjaarda, S Zarek, NJ Perkins, R Silver, N Galai, AH DeCherney, SL Mumford

Treatment of thyroid disorders before conception and in early pregnancy: a systematic review
R Vissenberg, E van den Boogaard, M van Wely, JA van der Post, E. Fliers, PH Bisschop, M Goddijn

Prior studies examining associations between subclinical hypothyroidism (SCH) and antithyroid antibodies with early pregnancy loss and live birth indicate mixed results and time to pregnancy (TTP) has not been studied in this patient population.

Objective

To examine associations of pre-pregnancy TSH concentrations and thyroid autoimmunity with TTP, pregnancy loss, and live birth among women with proven fecundity and a history of pregnancy loss.

Design

Prospective cohort study from a large, randomized controlled trial.

Setting

Four medical centers in the United States.

Patients or other participants

Healthy women, ages 18–40, who were actively attempting to conceive and had one or two prior pregnancy losses and no history of infertility.

Main Outcome Measure

TTP, pregnancy loss and live birth.

Results

Women with TSH higher than 2.5 did not have an increased risk of pregnancy loss or a decrease in live birth rate or TTP compared to women with TSH lower than 2.5 mIU/L after adjustment for age and body mass index. Similar findings were observed for women with thyroid autoimmunity and after additional adjustment for treatment assignment.

Conclusions

Among healthy fecund women with a history pregnancy loss, TSH levels higher than 2.5, or the presence of anti-thyroid antibodies, were not associated with fecundity, pregnancy loss or live
birth. Thus, women with SCH or thyroid autoimmunity can be reassured that their chances of conceiving and achieving a live birth are likely unaffected by marginal thyroid dysfunction.



Schildkliertje: T4-LIFE, onderzoek naar schildklier en miskramen
: T4-LIFE staat voor ‘Levothyroxine for euthyroid women with recurrent miscarriage and positive TPO antibodies’. Met deze studie wordt het ...

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