Maternal thyroid deficiency and pregnancy complications: implications for population screening.
OBJECTIVE
To examine the relation between certain pregnancy complications and thyroid stimulating hormone (TSH) measurements in a cohort of pregnant women.


METHODS
TSH was measured in sera obtained from women during the second trimester as part of routine prenatal care. Information was then collected about vaginal bleeding, premature delivery, low birthweight, abruptio placentae, pregnancy induced hypertension, need for cesarean section, low Apgar scores, and fetal and neonatal death.


RESULTS
Among 9403 women with singleton pregnancies, TSH measurements were 6 mU/l or greater in 209 (2.2%). The rate of fetal death was significantly higher in those pregnancies (3.8%) than in the women with TSH less than 6 mU/l (0.9%, odds ratio 4.4, 95% confidence interval 1.9-9.5). Other pregnancy complications did not occur more frequently.


CONCLUSIONS
From the second trimester onward, the major adverse obstetrical outcome associated with raised TSH in the general population is an increased rate of fetal death. If thyroid replacement treatment avoided this problem this would be another reason to consider population screening.
Allan
W C
WC
Foundation for Blood Research, Scarborough, Maine, USA. allan@fbr.org
Haddow
J E
JE
Palomaki
G E
GE
Williams
J R
JR
Mitchell
M L
ML
Hermos
R J
RJ
Faix
J D
JD
Klein
R Z
RZ
D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D036861:Delivery, Obstetric; D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis* / Q000453:epidemiology; D007231:Infant, Newborn; D008403:Mass Screening; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology; D013972:Thyrotropin / Q000097:blood*; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood
D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine