Thyroid hormone treatment among pregnant women with subclinical hypothyroidism: us national assessment
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2017-01-25Author
Maraka, Spyridoula
Mwangi, Raphael
McCoy, Rozalina G
Yao, Xiaoxi
Sangaralingham, Lindsey R
Singh Ospina, Naykky M
O’Keeffe, Derek T
De Ycaza, Ana E Espinosa
Rodriguez-Gutierrez, Rene
Coddington, Charles C
Stan, Marius N
Brito, Juan P
Montori, Victor M
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Maraka, Spyridoula; Mwangi, Raphael; McCoy, Rozalina G; Yao, Xiaoxi; Sangaralingham, Lindsey R; Singh Ospina, Naykky M; O’Keeffe, Derek T; De Ycaza, Ana E Espinosa; Rodriguez-Gutierrez, Rene; Coddington, Charles C; Stan, Marius N; Brito, Juan P; Montori, Victor M (2017). Thyroid hormone treatment among pregnant women with subclinical hypothyroidism: us national assessment. BMJ 356 ,
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Abstract
OBJECTIVE
To estimate the effectiveness and safety of thyroid hormone treatment among pregnant women with subclinical hypothyroidism.
DESIGN
Retrospective cohort study.
SETTING
Large US administrative database between 1 January 2010 and 31 December 2014.
PARTICIPANTS
5405 pregnant women with subclinical hypothyroidism, defined as untreated thyroid stimulating hormone (TSH) concentration 2.5-10 mIU/L.
EXPOSURE
Thyroid hormone therapy.
MAIN OUTCOME MEASURE
Pregnancy loss and other pre-specified maternal and fetal pregnancy related adverse outcomes.
RESULTS
Among 5405 pregnant women with subclinical hypothyroidism, 843 with a mean pre-treatment TSH concentration of 4.8 (SD 1.7) mIU/L were treated with thyroid hormone and 4562 with a mean baseline TSH concentration of 3.3 (SD 0.9) mIU/L were not treated (P< 0.01). Compared with the untreated group, treated women had lower adjusted odds of pregnancy loss (odds ratio 0.62, 95% confidence interval 0.48 to 0.82) but higher odds of preterm delivery (1.60, 1.14 to 2.24), gestational diabetes (1.37, 1.05 to 1.79), and pre-eclampsia (1.61, 1.10 to 2.37); other pregnancy related adverse outcomes were similar between the two groups. The adjusted odds of pregnancy loss were lower in treated women than in untreated women if their pre-treatment TSH concentration was 4.1-10 mIU/L (odds ratio 0.45, 0.30 to 0.65) but not if it was 2.5-4.0 mIU/L (0.91, 0.65 to 1.23) (P< 0.01).
CONCLUSION
Thyroid hormone treatment was associated with decreased risk of pregnancy loss among women with subclinical hypothyroidism, especially those with pre-treatment TSH concentrations of 4.1-10 mIU/L. However, the increased risk of other pregnancy related adverse outcomes calls for additional studies evaluating the safety of thyroid hormone treatment in this patient population.