title: Thyroid diseases and adverse pregnancy outcomes in a contemporary US cohort.
abstract: BACKGROUND
  Thyroid diseases are inconsistently reported to increase risk for pregnancy complications.
  
  
  OBJECTIVE
  The objective of this study was to study pregnancy complications associated with common and uncommon thyroid diseases.
  
  
  METHODS
  We analyzed singleton pregnancies (N = 223 512) from a retrospective US cohort, the Consortium on Safe Labor (2002-2008). Thyroid diseases and outcomes were derived from electronic medical records. Multivariable logistic regression with generalized estimating equations estimated adjusted odds ratios (ORs) with 99% confidence intervals (99% CI).
  
  
  METHODS
  Hypertensive diseases, diabetes, preterm birth, cesarean sections, inductions, and intensive care unit (ICU) admissions were analyzed.
  
  
  RESULTS
  Primary hypothyroidism was associated with increased odds of preeclampsia (OR = 1.47, 99% CI = 1.20-1.81), superimposed preeclampsia (OR = 2.25, 99% CI = 1.53-3.29), gestational diabetes (OR = 1.57, 99% CI = 1.33-1.86), preterm birth (OR = 1.34, 99% CI = 1.17-1.53), induction (OR = 1.15, 99% CI = 1.04-1.28), cesarean section (prelabor, OR = 1.31, 99% CI = 1.11-1.54; after spontaneous labor OR = 1.38, 99% CI = 1.14-1.66), and ICU admission (OR = 2.08, 99% CI = 1.04-4.15). Iatrogenic hypothyroidism was associated with increased odds of placental abruption (OR = 2.89, 99% CI = 1.14-7.36), breech presentation (OR = 2.09, 99% CI = 1.07-4.07), and cesarean section after spontaneous labor (OR = 2.05, 99% CI = 1.01-4.16). Hyperthyroidism was associated with increased odds of preeclampsia (OR = 1.78, 99% CI = 1.08-2.94), superimposed preeclampsia (OR = 3.64, 99% CI = 1.82-7.29), preterm birth (OR = 1.81, 99% CI = 1.32-2.49), induction (OR = 1.40, 99% CI = 1.06-1.86), and ICU admission (OR = 3.70, 99% CI = 1.16-11.80).
  
  
  CONCLUSIONS
  Thyroid diseases were associated with obstetrical, labor, and delivery complications. Although we lacked information on treatment during pregnancy, these nationwide data suggest either that there is a need for better thyroid disease management during pregnancy or that there may be an intrinsic aspect of thyroid disease that causes poor pregnancy outcomes.
authors.affiliation: Epidemiology Branch, Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Rockville, Maryland 20852, USA.
authors.forename: Tuija
authors.initials: T
authors.lastname: Männistö
authors.forename: Pauline
authors.initials: P
authors.lastname: Mendola
authors.forename: Jagteshwar
authors.initials: J
authors.lastname: Grewal
authors.forename: Yunlong
authors.initials: Y
authors.lastname: Xie
authors.forename: Zhen
authors.initials: Z
authors.lastname: Chen
authors.forename: S Katherine
authors.initials: SK
authors.lastname: Laughon
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D001946:Breech Presentation / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000209:etiology; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000453:epidemiology / Q000503:physiopathology*; D007037:Hypothyroidism / Q000453:epidemiology / Q000503:physiopathology*; D007049:Iatrogenic Disease / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012306:Risk; D014481:United States / Q000453:epidemiology; D055815:Young Adult