Thyroid disorder in pregnancy and postpartum with neonatal outcome a study in tertiary care centre

Authors

  • Bharati Das Department of Obstetrics and Gynecology, Post-Partum Programme, SCB Medical College and Hospital, Cuttack, Odisha, India
  • Puspanjali Khuntia Department of Obstetrics and Gynecology, Post-Partum Programme, SCB Medical College and Hospital, Cuttack, Odisha, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20191503

Keywords:

Hyperthyroidism, Hypothyroidism, Newborn, Post- partum, Pregnancy

Abstract

Background: Thyroid disorders are well known entity in pregnancy. Both mother and baby have to suffer from the consequences.  Lot of works has been done and many guidelines too came out over the years but what is actual understanding of the disease process by the mothers about themselves and for their babies especially in developing country like India remained uncovered. This has been analysed in present study.

Methods: It is a prospective observational study done in the post-partum programmed department of SCB medical college and hospital, a tertiary care center in eastern part of India for 3 years period. Thyroid dysfunction of the mothers and new born screening of thyroid function of their babies has been assessed.

Results: During this period total no of the babies along with their mothers were evaluated were 3762. Total no of thyroid disorders detected in 85 (2.25%) of mothers, among which hypothyroidism in 79 (2.09%) and hyperthyroidism in 6 (0.16%) were found. From total 85 cases, 79 (93%) mothers were hypothyroid   and 6 (7%) were hyperthyroid. Among the hypothyroid mothers 32 (40.5%) were diagnosed before present pregnancy and (59.5%) were diagnosed during pregnancy. In the babies of hypothyroid mother, new born screening for thyroid function was done only in 14 (17.7%) cases between 5-10 days.

Conclusions: Thyroid screening should be done in pregnancy as universal screening instead of high-risk cases. Documentation and interdepartmental coordination are very much essential in thyroid disorders for further decision by the physician for necessity of continuation of treatment and thyroid function test in the post-partum period for the mothers and its long-term consequences. It also guides the neonatologist or pediatrician doing thyroid function test of their babies. Ideally All newborns should be screened for congenital hypothyroidism as a part of new born screening (NBS) programmed. Effective communication with the mother and the family is very much essential for monitoring and treatment of both mother and the baby.

References

Burrow GN, Fisher DA, Larsen PR. Maternal and fetal thyroid function. New Eng J Med. 1994;331(16):1072-8.

Sahay RK, Nagesh VS. Hypothyroidism in pregnancy. Indian J Endocrinol Metabol. 2012;16(3):364.

Fan X, Wu L. The impact of thyroid abnormalities during pregnancy on subsequent neuropsychological development of the offspring: a meta-analysis. J Maternal Fetal Neonat Med. 2016;29(24):3971-6.

Maraka S, Mwangi R, McCoy RG, Yao X, Sangaralingham LR, Ospina NM, et al. Thyroid hormone treatment among pregnant women with subclinical hypothyroidism: US national assessment. BMJ. 2017;356:i6865.

Chen LM, Du WJ, Dai J, Zhang Q, Si GX, Yang H. Effects of subclinical hypothyroidism on maternal and perinatal outcomes during pregnancy: a single-center cohort study of a Chinese population. PloS One. 2014;9(10):e109364.

Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocrine Reviews. 2010;31(5):702-55.

Smallridge RC, Ladenson PW. Hypothyroidism in pregnancy: consequences to neonatal health. J Clinic Endocrinol Metabol. 2001;86(6):2349-53.

Lazarus JH. Thyroid function in pregnancy. British Med Bull. 2011;97:137-48.

Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American thyroid association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21(10):1081-125.

De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clinic Endocrinol Metabol. 2012;97(8):2543-65.

Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al Woeber for the American Association of Clinical Endocrinologists and American thyroid association taskforce on hypothyroidism in adults KA. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American association of clinical endocrinologist and American thyroid association. Endocr Pract .2012; 18:988-1028.

Lazarus J, Brown RS, Daumerie C, Hubalewska- Dydejczyk A, Negro R, Vaidya B, 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014;3:76-94.

Alexandar EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al, 2017 Guideline of American thyroid association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2017;27:315-89.

Smith A, Eccles- Smith J, D’Emden M, Lust K, Thyroid disorders in Pregnancy and Postpartum. Aust Prescr. 2017;41:214-9.

Dave A, Maru L, Tripathi M. Importance of Universal screening for thyroid disorders in first trimester of pregnancy. Indian J Endocrinol Metabol. 2014;18(5):735.

Taylor P, Lacey A, Thayer D, Draman M, Tabasum A, Muller I, et al Controlled antenatal thyroid screening study (CATS). N Engl J Med. 2012; 366:493-501.

Mintziori G, Goulis DG, Kolibianakis EM. Thyroid function and IVF outcome: when to investigate and when to intervene?. Current Opinion Obstet Gynecol. 2016;28(3):191-7.

Jayaraman M, Verma A, Harikumar KV, Ugale M, Modi K. Pregnancy outcomes with thyroxine replacement for subclinical hypothyroidism: Role of thyroid autoimmunity. Indian J Endocrinol Metabol. 2013;17(2):294.

Stagnaro-Green A. Postpartum management of women begun on levothyroxine during pregnancy. Front Endocrinol (Lausanne). 2015;6:183.

Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. New Eng J Med. 1999;341(8):549-55.

Shields BM, Knight BA, Hill AV, Hattersley AT, Vaidya B. Five-year follow-up for women with subclinical hypothyroidism in pregnancy. J Clinic Endocrinol Metabol. 2013;98(12):E1941-5.

Neelaveni K, Kumar KH, Sahay R, Ramesh J. Postpartum follow-up in women diagnosed with subclinical hypothyroidism during pregnancy. Indian J Endocrinol Metabol. 2017;21(5):699.

Pandey A, Das V, Agarwal A, Agrawal S, Misra D, Jaiswal N. Evaluation of obstetric near miss and maternal deaths in a tertiary care hospital in north India: shifting focus from mortality to morbidity. J Obstet Gynecol of India. 2014;64(6):394-9.

Ozdemir H, Akman I, Coskun S, Demirel U, Turan S, Bereket A, et al. Maternal thyroid dysfunction and neonatal thyroid problems. Int J Endocrinol. 2013;2013.

Derksen-Lubsen G, Verkerk PH. Neuropsychologic development in early treated congenital hypothyroidism: analysis of literature data. Pediat Res. 1996;39(3):561.

Ogundele MO, Waterson M. When should we be conducting thyroid function tests in newborns and young infants?. Arch Dis Childhood. 2010;95(2):151-2.

Shravani MR, Tharashree CD, Yashodha HT. Maternal hypothyroidism and neonatal outcome. Int J Contemp Pediatr.2018;5(2):600-4.

Desai MP, Sharma R, Riaz I, Sudhanshu S, Parikh R, Bhatia V. Newborn screening Guidelines for congenital hypothyroidism in India: recommendations of the Indian society for pediatric and adolescent endocrinology (ISPAE) - Part I: screening and confirmation of diagnosis. Indian J Pediat. 2018;85(6):440-7.

Desai MP, Sharma R, Riaz I, Sudhanshu S, Parikh R, Bhatia V. Newborn screening guidelines for congenital hypothyroidism in India: recommendations of the Indian society for pediatric and adolescent endocrinology (ISPAE)–Part I: screening and confirmation of diagnosis. Indian J Pediat. 2018;85(6):440-7.

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Published

2019-04-29

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Original Research Articles