Association of Thyroid Function Test Abnormalities and Thyroid Autoimmunity With Preterm Birth A Systematic Review and Meta-analysis
Por:
Consortium on Thyroid and Pregnancy—Study Group on Preterm Birth, Korevaar TIM, Derakhshan A, Taylor PN, Meima M, Chen L, Bliddal S, Carty DM, Meems M, Vaidya B, Shields B, Ghafoor F, Popova PV, Mosso L, Oken E, Suvanto E, Hisada A, Yoshinaga J, Brown SJ, Bassols J, Auvinen J, Bramer WM, López-Bermejo A, Dayan C, Boucai L, Vafeiadi M, Grineva EN, Tkachuck AS, Pop VJM, Vrijkotte TG, Guxens M, Chatzi L, Sunyer J, Jiménez-Zabala A, Riaño I, Murcia M, Lu X, Mukhtar S, Delles C, Feldt-Rasmussen U, Nelson SM, Alexander EK, Chaker L, Männistö T, Walsh JP, Pearce EN, Steegers EAP and Peeters RP
Publicada:
20 ago 2019
Categoría:
Medicine (miscellaneous)
Resumen:
IMPORTANCE Maternal hypothyroidism and hyperthyroidism are risk factors for preterm birth. Milder thyroid function test abnormalities and thyroid autoimmunity are more prevalent, but it remains controversial if these are associated with preterm birth.
OBJECTIVE To study if maternal thyroid function test abnormalities and thyroid autoimmunity are risk factors for preterm birth.
DATA SOURCES AND STUDY SELECTION Studies were identified through a search of the Ovid MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, and Google Scholar databases from inception to March 18, 2018, and by publishing open invitations in relevant journals. Data sets from published and unpublished prospective cohort studies with data on thyroid function tests (thyrotropin [often referred to as thyroid-stimulating hormone or TSH] and free thyroxine [FT4] concentrations) or thyroid peroxidase (TPO) antibody measurements and gestational age at birth were screened for eligibility by 2 independent reviewers. Studies in which participants received treatment based on abnormal thyroid function tests were excluded.
DATA EXTRACTION AND SYNTHESIS The primary authors provided individual participant data that were analyzed using mixed-effects models.
MAIN OUTCOMES AND MEASURES The primary outcome was preterm birth (<37 weeks' gestational age).
RESULTS From 2526 published reports, 35 cohorts were invited to participate. After the addition of 5 unpublished data sets, a total of 19 cohorts were included. The study population included 47045 pregnant women (mean age, 29 years; median gestational age at blood sampling, 12.9 weeks), of whom 1234 (3.1%) had subclinical hypothyroidism (increased thyrotropin concentration with normal FT4 concentration), 904 (2.2%) had isolated hypothyroxinemia (decreased FT4 concentration with normal thyrotropin concentration), and 3043 (7.5%) were TPO antibody positive; 2357 (5.0%) had a preterm birth. The risk of preterm birth was higher for women with subclinical hypothyroidism than euthyroid women (6.1% vs 5.0%, respectively; absolute risk difference, 1.4% [95% CI, 0%-3.2%]; odds ratio [OR], 1.29 [95% CI, 1.01-1.64]). Among women with isolated hypothyroxinemia, the risk of preterm birth was 7.1% vs 5.0% in euthyroid women (absolute risk difference, 2.3% [95% CI, 0.6%-4.5%]; OR, 1.46 [95% CI, 1.12-1.90]). In continuous analyses, each 1-SD higher maternal thyrotropin concentration was associated with a higher risk of preterm birth (absolute risk difference, 0.2% [95% CI, 0%-0.4%] per 1 SD; OR, 1.04 [95% CI, 1.00-1.09] per 1 SD). Thyroid peroxidase antibody-positive women had a higher risk of preterm birth vs TPO antibody-negative women (6.6% vs 4.9%, respectively; absolute risk difference, 1.6% [95% CI, 0.7%-2.8%]; OR, 1.33 [95% CI, 1.15-1.56]).
CONCLUSIONS AND RELEVANCE Among pregnant women without overt thyroid disease, subclinical hypothyroidism, isolated hypothyroxinemia, and TPO antibody positivity were significantly associated with higher risk of preterm birth. These results provide insights toward optimizing clinical decision-making strategies that should consider the potential harms and benefits of screening programs and levothyroxine treatment during pregnancy.
Filiaciones:
Korevaar TIM:
Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
Derakhshan A:
Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
Taylor PN:
Thyroid Research Group, Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, England
Meima M:
Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
Chen L:
Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
Bliddal S:
Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
Carty DM:
Department of Diabetes, Endocrinology, and Clinical Pharmacology, Glasgow Royal Infirmary, Glasgow, Scotland
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
Meems M:
Departments of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
Vaidya B:
Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, University of Exeter Medical School, Exeter, England
Shields B:
Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, England
Ghafoor F:
National Health Research Complex, Shaikh Zayed Medical Complex, Lahore, Pakistan
Popova PV:
Almazov National Medical Research Centre, St Petersburg, Russia
Department of Internal Diseases and Endocrinology, St Petersburg Pavlov State Medical University, St Petersburg, Russia
Mosso L:
Department of Endocrinology, Pontificia Universidad Catolica de Chile, Santiago
Oken E:
Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
Suvanto E:
Department of Obstetrics and Gynecology and Medical Research Center Oulu, University of Oulu, Oulu, Finland
Hisada A:
Center for Preventive Medical Science, Chiba University, Chiba, Japan
Yoshinaga J:
Faculty of Life Sciences, Toyo University, Gunma, Japan
Brown SJ:
Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
Bassols J:
Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute, Dr Josep Trueta Hospital, Girona, Spain
Auvinen J:
Medical Research Center Oulu, Oulu University Hospital, Center for Life Course Health Research, University of Oulu, Oulu, Finland
Bramer WM:
Medical Library, Erasmus University Medical Center, Rotterdam, the Netherlands
López-Bermejo A:
Pediatric Endocrinology Research Group, Girona Biomedical Research Institute, Dr Josep Trueta Hospital, Girona, Spain
Dayan C:
Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, England
Boucai L:
Division of Endocrinology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell University, New York, New York
Vafeiadi M:
Department of Social Medicine, University of Crete, Heraklion, Greece
Grineva EN:
Almazov National Medical Research Centre, St Petersburg, Russia
Department of Internal Diseases and Endocrinology, St Petersburg Pavlov State Medical University, St Petersburg, Russia
Tkachuck AS:
Almazov National Medical Research Centre, St Petersburg, Russia
Department of Internal Diseases and Endocrinology, St Petersburg Pavlov State Medical University, St Petersburg, Russia
Pop VJM:
Departments of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
Vrijkotte TG:
Department of Public Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
Guxens M:
ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain
Pompeu Fabra University, Barcelona, Spain
Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
Chatzi L:
Keck School of Medicine, Department of Preventive Medicine, University of Southern California, Los Angeles
Sunyer J:
ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain
Pompeu Fabra University, Barcelona, Spain
Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
Hospital del Mar Medical Research Institute, Barcelona, Spain
Jiménez-Zabala A:
Biodonostia Health Research Institute, San Sebastián, Spain
Public Health Division of Gipuzkoa, Basque Government, San Sebastián, Spain
Riaño I:
Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
AGC Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain
:
Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
Lu X:
Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
Mukhtar S:
Department of Gynecology and Obstetrics, Shaikh Zayed Medical Complex, Lahore, Pakistan
Delles C:
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
Feldt-Rasmussen U:
Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
Nelson SM:
School of Medicine, University of Glasgow, Glasgow, Scotland
National Institute for Health Research, Bristol Biomedical Research Centre, Bristol, England
Alexander EK:
Division of Endocrinology, Hypertension, and Diabetes, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Chaker L:
Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
Männistö T:
Northern Finland Laboratory Center Nordlab and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
Walsh JP:
Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute, Dr Josep Trueta Hospital, Girona, Spain
Medical School, University of Western Australia, Crawley
Pearce EN:
Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
Steegers EAP:
Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, the Netherlands
Peeters RP:
Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
Green Accepted, Green Published, Bronze
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