The Effect of Thyroid Dysfunction on Pregnancy Outcome: Systematic Review and Meta-Analysis

Heni Elmiani Sari

doi:10.37287/ijghr.v6i1.2674

Heni Elmiani Sari Polytechnic of Borneo Medistra

DOI: https://doi.org/10.37287/ijghr.v6i1.2674

Keywords: effect thyroid, thyroid dysfunction, pregnancy outcome, meta-analysis

Abstract

Thyroid dysfunction during pregnancy certain impact on pregnancy outcomes, and neonatal growth. The incidence of pregnancy with hyperthyroidism ranges from 0.5% to 1%, leading to adverse pregnancy outcomes such as abortion, premature delivery, stillbirth, gestational hypertension, placental abruption, and premature rupture of membranes. This study aimed to analyzed the effect thyroid dysfunction on pregnancy outcomes. This was a systematic review and meta-analysis. The PICO research question as follows. Population: Pregnancy; Intervention: Dysfunction Thyroid; Comparison: Thyroid Normal; Outcome: Effect of Pregnancy. The articles were obtained from four databases: PubMed, Web of Science, Springer, and Science Direct. The Keywords were “Thyroid Dysfunction” OR “Pregnancy” OR “Outcomes” AND “Prospective Cohort” AND “Retrospective comparative”. Full text article in English with study design Cohort and retrospective comparative from 2012 to 2022, were included in this study. The steps of meta-analysis followed PRISMA flow diagram. The Articles were analyzed by the Review Manager 5.4 application A total 11 cohort and retrospective comparative from India, Israel, Denmark, Pakistan, America, Finland, and China were selected for a systematic review and meta-analysis. the data collected showed that effect of thyroid disfunction on pregnancy outcome among preterm birth by 0.87 times and was statistically significant (SMD=0.87, 95% CI=0.87 to 0.93; P<0.00001); Pre-Eclampsia by 0.70 times (SMD=0.70, 95% CI=0.50 to 0.96; P=0.03); Placenta abruption by 0.27 times (SMD=0.27, 95% CI=0.19 to 0.38; P<0.00001); Fetal Distress by 0.77 times (SMD=0,77, 95% CI=0.68 to 0.86; P<0.00001); Post-partum Hemorrhage by 0.57 times (SMD=0.57, 95% CI= 0.37 to 0.87; P<0.009).

References

Ajmani, S. N., Aggarwal, D., Bhatia, P., Sharma, M., Sarabhai, V., & Paul, M. (2014). Prevalence of overt and subclinical thyroid dysfunction among pregnant women and its effect on maternal and fetal outcome. Journal of Obstetrics and Gynecology of India, 64(2), 105–110. https://doi.org/10.1007/s13224-013-0487-y

Alexander, E. K., Pearce, E. N., Brent, G. A., Brown, R. S., Chen, H., Dosiou, C., Grobman, W. A., Laurberg, P., Lazarus, J. H., Mandel, S. J., Peeters, R. P., & Sullivan, S. (2017). 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum. Thyroid, 27(3), 315–389. https://doi.org/10.1089/thy.2016.0457

Angell, T. E., & Alexander, E. K. (2019). Thyroid Nodules and Thyroid Cancer in the Pregnant Woman. Endocrinology and Metabolism Clinics of North America, 48(3), 557–567. https://doi.org/10.1016/j.ecl.2019.05.003

Arbib, N., Hadar, E., Sneh-Arbib, O., Chen, R., Wiznitzer, A., & Gabbay-Benziv, R. (2017). First trimester thyroid stimulating hormone as an independent risk factor for adverse pregnancy outcome. Journal of Maternal-Fetal and Neonatal Medicine, 30(18), 2174–2178. https://doi.org/10.1080/14767058.2016.1242123

Bekkering, G. E., Agoritsas, T., Lytvyn, L., Heen, A. F., Feller, M., Moutzouri, E., Abdulazeem, H., Aertgeerts, B., Beecher, D., Brito, J. P., Farhoumand, P. D., Singh Ospina, N., Rodondi, N., Van Driel, M., Wallace, E., Snel, M., Okwen, P. M., Siemieniuk, R., Vandvik, P. O., … Vermandere, M. (2019). Thyroid hormones treatment for subclinical hypothyroidism: A clinical practice guideline. The BMJ, 365, 1–9. https://doi.org/10.1136/bmj.l2006

De Groot, L., Abalovich, M., Alexander, E. K., Amino, N., Barbour, L., Cobin, R. H., Eastman, C. J., Lazarus, J. H., Luton, D., Mandel, S. J., Mestman, J., Rovet, J., & Sullivan, S. (2012). Management of thyroid dysfunction during pregnancy and postpartum: An endocrine society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 97(8), 2543–2565. https://doi.org/10.1210/jc.2011-2803

Elhaj, E. T., Adam, I., Alim, A., Elhassan, E. M., & Lutfi, M. (2015). Thyroid function/antibodies in Sudanese patients with preeclampsia. Frontiers in Endocrinology, 6(MAY), 6–11. https://doi.org/10.3389/fendo.2015.00087

Feldthusen, A. D., Larsen, J., Pedersen, P. L., Kristensen, T. T., & Kvetny, J. (2014). Pregnancy-induced alterations in mitochondrial function in euthyroid pregnant women and pregnant women with subclinical hypothyroidism; Relation to adverse outcome. Journal of Clinical and Translational Endocrinology, 1(1), e13–e17. https://doi.org/10.1016/j.jcte.2013.12.003

Gauthier, B. R., Sola-García, A., Cáliz-Molina, M. Á., Lorenzo, P. I., Cobo-Vuilleumier, N., Capilla-González, V., & Martin-Montalvo, A. (2020). Thyroid hormones in diabetes, cancer, and aging. Aging Cell, 19(11), 1–25. https://doi.org/10.1111/acel.13260

Grammatikakis, I., Zervoudis, S., Fotopoulos, S., & ... (2017). Prevalence of maternal hypothyroidism complicated with preeclampsia: a retrospective analysis of 60 cases. The Medical-Surgical …, 121(2), 253–257. https://www.revmedchir.ro/index.php/revmedchir/article/view/87

Guo, W., Wang, W., Jin, Y., Chen, W., Chen, L., Lin, L., Cheng, Y., Cui, T., Chen, Y., Pan, Z., Shen, J., Tan, L., Gao, M., Zhang, Y., & Zhang, W. (2020). Trimester-Specific Thyroid Function in Pregnant Women with Different Iodine Statuses. Annals of Nutrition and Metabolism, 76(3), 165–174. https://doi.org/10.1159/000506276

Hajifoghaha, M., Teshnizi, S. H., Forouhari, S., & Dabbaghmanesh, M. H. (2022). Association of thyroid function test abnormalities with preeclampsia: a systematic review and meta-analysis. BMC Endocrine Disorders, 22(1), 1–19. https://doi.org/10.1186/s12902-022-01154-9

Hammad, M. A., Sulaiman, S. A. S., Aziz, N. A., & Noor, D. A. M. (2019). Prescribing statins among patients with type 2 diabetes: The clinical gap between the guidelines and practice. Journal of Research in Medical Sciences, 24(1), 1–5. https://doi.org/10.4103/jrms.JRMS

Hirsch, D., Levy, S., Nadler, V., Kopel, V., Shainberg, B., & Toledano, Y. (2013). Pregnancy outcomes in women with severe hypothyroidism. European Journal of Endocrinology, 169(3), 313–320. https://doi.org/10.1530/EJE-13-0228

Hosen, B., Banna, H. Al, Kabir, Y., & Howlader, M. Z. H. (2014). Biojournal of Science and Technology Association of Maternal Hypothyroidism with Preeclampsia in Bangladeshi population.

Karakosta, P., Alegakis, D., Georgiou, V., Roumeliotaki, T., Fthenou, E., Vassilaki, M., Boumpas, D., Castanas, E., Kogevinas, M., & Chatzi, L. (2012). Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes. Journal of Clinical Endocrinology and Metabolism, 97(12), 4464–4472. https://doi.org/10.1210/jc.2012-2540

Kiran, Z., Sheikh, A., & Islam, N. (2021). Association of thyroid antibodies status on the outcomes of pregnant women with hypothyroidism (maternal hypothyroidism on pregnancy outcomes, MHPO-4). BMC Pregnancy and Childbirth, 21(1), 1–12. https://doi.org/10.1186/s12884-021-03594-y

Konar, H., Sarkar, M., & Roy, M. (2018). Association of Thyroid Dysfunction and Autoimmunity in Pregnant Women with Diabetes Mellitus. Journal of Obstetrics and Gynecology of India, 68(4), 283–288. https://doi.org/10.1007/s13224-017-1033-0

Krysiak, R., Szkróbka, W., & Okopień, B. (2019). The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto’s Thyroiditis: A Pilot Study. Experimental and Clinical Endocrinology and Diabetes, 127(7), 417–422. https://doi.org/10.1055/a-0653-7108

Kumru, P., Erdogdu, E., Arisoy, R., Demirci, O., Ozkoral, A., Ardic, C., Ertekin, A. A., Erdogan, S., & Ozdemir, N. N. (2015). Effect of thyroid dysfunction and autoimmunity on pregnancy outcomes in low risk population. Archives of Gynecology and Obstetrics, 291(5), 1047–1054. https://doi.org/10.1007/s00404-014-3533-9

Kurimoto, C., Inaba, H., Ariyasu, H., Iwakura, H., Ueda, Y., Uraki, S., Takeshima, K., Furukawa, Y., Morita, S., Yamamoto, Y., Yamashita, S., Katsuda, M., Hayata, A., Akamatsu, H., Jinnin, M., Hara, I., Yamaue, H., & Akamizu, T. (2020). Predictive and sensitive biomarkers for thyroid dysfunctions during treatment with immune-checkpoint inhibitors. Cancer Science, 111(5), 1468–1477. https://doi.org/10.1111/cas.14363

Luewan, S., Chakkabut, P., & Tongsong, T. (2011). Outcomes of pregnancy complicated with hyperthyroidism: A cohort study. Archives of Gynecology and Obstetrics, 283(2), 243–247. https://doi.org/10.1007/s00404-010-1362-z

Luton, D., Le Gac, I., Vuillard, E., Castanet, M., Guibourdenche, J., Noel, M., Toubert, M. E., Léger, J., Boissinot, C., Schlageter, M. H., Garel, C., Tébeka, B., Oury, J. F., Czernichow, P., & Polak, M. (2005). Management of Graves’ disease during pregnancy: The key role of fetal thyroid gland monitoring. Journal of Clinical Endocrinology and Metabolism, 90(11), 6093–6098. https://doi.org/10.1210/jc.2004-2555

Männistö, T., Mendola, P., Reddy, U., & Laughon, S. K. (2013). Neonatal outcomes and birth weight in pregnancies complicated by maternal thyroid disease. American Journal of Epidemiology, 178(5), 731–740. https://doi.org/10.1093/aje/kwt031

Maraka, S., Mwangi, R., McCoy, R. G., Yao, X., Sangaralingham, L. R., Singh Ospina, N. M., O’Keeffe, D. T., De Ycaza, A. E. E., Rodriguez-Gutierrez, R., Coddington, C. C., Stan, M. N., Brito, J. P., & Montori, V. M. (2017). Thyroid hormone treatment among pregnant women with subclinical hypothyroidism: US national assessment. BMJ (Online), 356(January), 1–12. https://doi.org/10.1136/bmj.i6865

Moleti, M., Di Mauro, M., Sturniolo, G., Russo, M., & Vermiglio, F. (2019). Hyperthyroidism in the pregnant woman: Maternal and fetal aspects. Journal of Clinical and Translational Endocrinology, 16(March), 100190. https://doi.org/10.1016/j.jcte.2019.100190

Murti B (2018). Prinsip dan Metode Riset Epidemiologi (5th ed) (Principles and Methods of Epidemiological Research (5th ed). Surakarta: Program Studi Ilmu Kesehatan Masyarakat, Program Pascasarjana, Universitas Sebelas Maret

Negro, R., Formoso, G., Mangieri, T., Pezzarossa, A., Dazzi, D., & Hassan, H. (2006). Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: Effects on obstetrical complications. Journal of Clinical Endocrinology and Metabolism, 91(7), 2587–2591. https://doi.org/10.1210/jc.2005-1603

Ollero, M. D., Pineda, J., Martínez de Esteban, J. P., Toni, M., Espada, M., & Anda, E. (2019). Optimization of the follow-up of pregnant women with autoimmune thyroid disease. Endocrinología, Diabetes y Nutrición (English Ed.), 66(5), 305–311. https://doi.org/10.1016/j.endien.2018.08.010

Sepasi, F., Rashidian, T., Shokri, M., Badfar, G., Kazemi, F., & Azami, M. (2020). Thyroid dysfunction in Iranian pregnant women: A systematic review and meta-analysis. BMC Pregnancy and Childbirth, 20(1), 1–15. https://doi.org/10.1186/s12884-020-03040-5

Stagnaro-Green, A., Dong, A., & Stephenson, M. D. (2020). Universal screening for thyroid disease during pregnancy should be performed. Best Practice and Research: Clinical Endocrinology and Metabolism, 34(4), 101320. https://doi.org/10.1016/j.beem.2019.101320

Turunen, S., Vääräsmäki, M., Lahesmaa-Korpinen, A. M., Leinonen, M. K., Gissler, M., Männistö, T., & Suvanto, E. (2020). Maternal hyperthyroidism and pregnancy outcomes: A population-based cohort study. Clinical Endocrinology, 93(6), 721–728. https://doi.org/10.1111/cen.14282

Wildisen, L., Feller, M., Del Giovane, C., Moutzouri, E., Du Puy, R. S., Mooijaart, S. P., Collet, T. H., Poortvliet, R. K. E., Kearney, P., Quinn, T. J., Klöppel, S., Bauer, D. C., Peeters, R. P., Westendorp, R., Aujesky, D., Gussekloo, J., & Rodondi, N. (2021). Effect of Levothyroxine Therapy on the Development of Depressive Symptoms in Older Adults with Subclinical Hypothyroidism: An Ancillary Study of a Randomized Clinical Trial. JAMA Network Open, 4(2), 36645. https://doi.org/10.1001/jamanetworkopen.2020.36645

Yuan, X., Zhao, J., Wang, J., Zheng, W., Kong, Y., & Li, G. (2023). Pregnancy outcomes and neonatal thyroid function in women with thyroid cancer: a retrospective study. BMC Pregnancy and Childbirth, 23(1), 1–9. https://doi.org/10.1186/s12884-023-05588-4

Zhang, Y., Li, Y., Shan, Z., Xu, Y., Li, C., Xie, X., Li, Y., Wang, W., Mao, J., & Teng, W. (2019). Association of Overt and Subclinical Hyperthyroidism during Weeks 4-8 with Adverse Pregnancy Outcomes. Journal of Women’s Health, 28(6), 842–848. https://doi.org/10.1089/jwh.2018.7180.