title: Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death.
abstract: BACKGROUND
  To examine the relationship between maternal TSH and free thyroxine (FT(4)) concentrations in early pregnancy and the risk of miscarriage, fetal or neonatal death.
  
  
  METHODS
  Cohort study of 2497 Dutch women. TSH, FT(4), and thyroid peroxidase antibodies concentrations were determined at first booking. Child loss was operationalized as miscarriage, fetal or neonatal death. Women with overt thyroid dysfunction were excluded.
  
  
  RESULTS
  Twenty-seven cases of child loss were observed. The mean TSH and FT(4) level in the women with child loss was 1.48 mU/l and 9.82 pmol/l compared with 1.11 mU/l and 9.58 pmol/l in women without child loss. The incidence of child loss increased by 60% (OR=1.60 (95% confidence interval (CI): 1.04-2.47)) for every doubling in TSH concentration. This association remained after adjustment for smoking, age, parity, diabetes mellitus, hypertension, previous preterm deliveries, and previous preterm stillbirth/miscarriage (adjusted odds ratio=1.80 (95% CI: 1.07-3.03)). This was not true for FT(4) concentrations (OR=1.41 (95% CI: 0.21-9.40); P=0.724).
  
  
  CONCLUSIONS
  In a cohort of pregnant women without overt thyroid dysfunction, the risk of child loss increased with higher levels of maternal TSH. Maternal FT(4) concentrations and child loss were not associated.
authors.affiliation: Departments of Endocrinology and Metabolism Clinical Epidemiology, Biostatistics and Bioinformatics Social Science, Academic Medical Centre of the University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. n.benhadi@amc.uva.nl
authors.forename: N
authors.initials: N
authors.lastname: Benhadi
authors.forename: W M
authors.initials: WM
authors.lastname: Wiersinga
authors.forename: J B
authors.initials: JB
authors.lastname: Reitsma
authors.forename: T G M
authors.initials: TG
authors.lastname: Vrijkotte
authors.forename: G J
authors.initials: GJ
authors.lastname: Bonsel
mesh_terms: D000022:Abortion, Spontaneous / Q000097:blood*; D000328:Adult; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005313:Fetal Death; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood*; D012307:Risk Factors; D050497:Stillbirth; D013972:Thyrotropin / Q000097:blood*; D013974:Thyroxine / Q000097:blood; D055815:Young Adult
chemical_list: D013972:Thyrotropin; D013974:Thyroxine