title: Association between previously unknown connective tissue disease and subclinical hypothyroidism diagnosed during first trimester of pregnancy.
abstract: OBJECTIVE
  To investigate the presence of autoimmune rheumatic disorders among women with autoimmune thyroid disorders diagnosed during the first trimester of pregnancy and subsequent pregnancy outcomes.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Tertiary obstetric and gynecologic center.
  
  
  METHODS
  Pregnant women in the first trimester of pregnancy.
  
  
  METHODS
  Clinical, laboratory, ultrasonographic evaluations.
  
  
  METHODS
  Thyroid-stimulating hormone (TSH) level; antibodies against thyroperoxidase, thyroid globulin and TSH receptor detection; screening for rheumatic symptoms and antinuclear antibodies (ANA); uterine artery pulsatility index evaluation; pregnancy complication onset.
  
  
  RESULTS
  Out of 3,450 women enrolled, 106 (3%) were diagnosed with autoimmune thyroid disorders. ANA were present in 18 (16.9%) of 106 cases and 26 (12.6%) of 206 controls. Of the cases, 28 (26.4%) of 106 reported rheumatic symptoms, 5 of these were diagnosed with Sjögren syndrome or with undefined connective tissue disease. Autoimmune thyroid diseases are statistically significantly associated with a higher risk of preeclampsia, fetal growth restriction, and overall pregnancy complications compared with controls, with a higher uterine artery pulsatility index, suggesting a defective placentation in thyroid disorders. The effect of ANA-positivity on moderate/severe adverse pregnancy outcomes was statistically significant among the patients with thyroid disorders (9 of 18 as compared to 8 of 88, odds ratio 9.65; 95% confidence interval, 2.613-7.81).
  
  
  CONCLUSIONS
  Connective tissue diseases are frequently associated with autoimmune thyroid disorders diagnosed during the first trimester of pregnancy. Thyroid autoimmunity and ANA positivity independently increased the risk of adverse pregnancy outcomes.
authors: Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy.
authors: Fausta
authors: F
authors: Beneventi
authors: Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy. Electronic address: elena.loc@libero.it.
authors: Elena
authors: E
authors: Locatelli
authors: Clinical Chemistry Laboratory, IRCCS Foundation Policlinico San Matteo, Pavia, Italy.
authors: Claudia
authors: C
authors: Alpini
authors: First Department of Medicine, IRCCS Foundation Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors: Elisabetta
authors: E
authors: Lovati
authors: Division of Rheumatology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy.
authors: Véronique
authors: V
authors: Ramoni
authors: Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy.
authors: Margherita
authors: M
authors: Simonetta
authors: Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy.
authors: Chiara
authors: C
authors: Cavagnoli
authors: Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy.
authors: Arsenio
authors: A
authors: Spinillo
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D058070:Asymptomatic Diseases; D001327:Autoimmune Diseases / Q000097:blood / Q000209:etiology* / Q000276:immunology*; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003240:Connective Tissue Diseases / Q000097:blood / Q000175:diagnosis / Q000276:immunology*; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000097:blood / Q000175:diagnosis / Q000276:immunology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000175:diagnosis / Q000276:immunology*; D011261:Pregnancy Trimester, First / Q000097:blood; D012307:Risk Factors; D013960:Thyroid Function Tests; D013963:Thyroid Hormones / Q000097:blood
chemical_list: D000974:Antibodies, Antinuclear; D015415:Biomarkers; D013963:Thyroid Hormones
keywords: Antinuclear antibodies; pregnancy; subclinical hypothyroidism