The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Evaluation of prevalence of Thyroid Peroxidase Antibody and therapeutic effect of levothyroxine on pregnancy outcome in positive antibody pregnant women

Document Type : Original Article

Authors
Fariba Seyedoshohadaie 1
Shahla Nouroozi 2
Shole Shahgheibi 1
Robabe Mohammadbeigi 1
Nasrin Sufizadeh 3
Masomeh Rezaei 3
1 Associate professor, Department of Obstetrics and Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Kurdistan, Iran.
2 Resident of Obstetrics and Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Kurdistan, Iran.
3 Assistant professor, Department of Obstetrics and Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Kurdistan, Iran.
10.22038/ijogi.2014.3248
Abstract
Introduction: Thyroid peroxides antibodies are associated with recognized complications during and after pregnancy like Abortion and postpartum depression, but other complications such as preterm labor, preterm rupture of membrane(PROM) and effect of antibodies on newborns weight and newborns Apgar score not be evaluated. Studies were demonstrated, treatment with levothyroxine in pregnant women with thyroid peroxides antibodies may prevent maternal and fetal complications. This study illustrated the prevalence of thyroid peroxides antibodies and induced pregnancy complications and then evaluates the effects of levothyroxine in reducing pregnancy complications among pregnant women having such antibodies.
Methods and materials: we designed single blind RCT study in 300 first trimester pregnant women attending Prenatal Clinic in Sanandaj from September 2009 to January 2011. of 266 pregnant women without clinical hypothyroidism, 32 women were thyroid peroxides antibody positive. This 32 thyroid peroxides antibody positive women were divided in two groups via simple randomized allocation. Intervention group received a daily dose of 50 microgram levothyroxine in the pregnancy period. Control group did not receive any treatment. Participants were observed until the end of pregnancy period and outcome was assessed. Then data was analyzed by SPSS 11.5 software and Chi square, Fisher and Kruskal-Wallis test. P-values less than 0.05 were considered statistically significant.
Results: of 266 pregnant women, 32 women (12%) were thyroid peroxides antibody positive. There were no significant statistical differences between delivery type and delivery time. (p=0.37) Though premature delivery and premature rupture of membrane in treated group was lower than non-treated group and the average of newborns weight and newborns Apgar score was higher than non-treated group, this difference was not statistically significant. (p=0.22, p=0.34 and p=0.16)
Conclusion: Add tests for thyroid peroxidase antibodies to pregnancy care and treatment with levothyroxine in pregnant women with thyroid peroxides antibodies can reduce premature delivery and premature rupture of membrane and increase the average of newborns weight and newborns Apgar score.
Keywords
thyroid peroxides antibody
Levothyroxine
Abortion
PROM
  1. Gisel JJ, Daniels JT, Burger CD. Clinical utility of thyroperoxidase antibody testing in patients with pulmonary hypertension. Thyroid Sci 2009;4(8):CLS1-5.
  2. Chiovato L, Bassi P, Santini F, Mammoli C, Lapi P, Carayon P, et al. Antibodies producing complementmediated thyroid cytotoxicity in patients with atrophic or goitrous autoimmune thyroiditis. J Clin Endocrinol Metab 1993 Dec;77(6):1700-5.
  3. Bulow Pedersen I, Laurberg P, Knudsen N, Jorgensen T, Perrild H, Ovesen L, et al. Lack of association between thyroid autoantibodies and parity in a population study argues against microchimerism as a trigger of thyroid autoimmunity. Eur J Endocrinol 2006 Jan;154(1):39-45
  4. Poppe K, Glinoer D. Thyroid autoimmunity and hypothyroidism before and during pregnancy. Hum Reprod Update 2003 Mar-Apr;9(2):149-61
  5. Walsh JP, Bremner AP, Bulsara MK, O'Leary P, Leedman PJ, Feddema P, et al. Parity and the risk of autoimmune thyroid disease: a community-based study. J Clin Endocrinol Metab 2005 Sep;90(9):5309-12.
  6. Gerstein HC. How common is postpartum thyroiditis? A methodologic overview of the literature. Arch Intern Med 1990 Jul;150(7):1397-400.
  7. Pop VJ, de Rooy HA, Vader HL, van der Heide D, van Son MM, Komproe IH. Microsomal antibodies during gestation in relation to postpartum thyroid dysfunction and depression. Acta Endocrinol (Copenh) 1993 Jul;129(1):26-30.
  8. Kuijpens JL, Pop VJ, Vader HL, Drexhage HA, Wiersinga WM. Prediction of post partum thyroid dysfunction: can it be improved? Eur J Endocrinol 1998 Jul;139(1):36-43.
  9. Kutteh WH, Schoolcraft WB, Scott RT. Antithyroid antibodies do not affect pregnancy outcome in women undergoing assisted reproduction. Hum Reprod 1999 Nov;14(11):2886-90.
  10. Mannisto T, Vaarasmaki M, Pouta A, Hartikainen AL, Ruokonen A, Surcel HM, et al. Perinatal outcome of children born to mothers with thyroid dysfunction or antibodies: a prospective population-based cohort study. J Clin Endocrinol Metab 2009 Mar;94(3):772-9.
  11. Rushworth FH, Backos M, Rai R, Chilcott IT, Baxter N, Regan L. Prospective pregnancy outcome in untreated recurrent miscarriers with thyroid autoantibodies. Hum Reprod 2000 Jul;15(7):1637-9.
  12. Poppe K, Glinoer D, Van Steirteghem A, Tournaye H, Devroey P, Schiettecatte J, et al. Thyroid dysfunction and autoimmunity in infertile women. Thyroid 2002 Nov;12(11):997-1001.
  13. Allan WC, Haddow JE, Palomaki GE, Williams JR, Mitchell ML, Hermos RJ, et al. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen 2000;7(3):127-30.
  14. Nohr SB, Jorgensen A, Pedersen KM, Laurberg P. Postpartum thyroid dysfunction in pregnant thyroid peroxidase antibody-positive women living in an area with mild to moderate iodine deficiency: is iodine supplementation safe? J Clin Endocrinol Metab 2000 Sep;85(9):3191-8.
  15. Premawardhana LD, Parkes AB, Ammari F, John R, Darke C, Adams H, et al. Postpartum thyroiditis and longterm thyroid status: prognostic influence of thyroid peroxidase antibodies and ultrasound echogenicity. J Clin Endocrinol Metab 2000 Jan;85(1):71-5.
  16. Harris B, Oretti R, Lazarus J, Parkes A, John R, Richards C, et al. Randomised trial of thyroxine to prevent postnatal depression in thyroid-antibody-positive women. Br J Psychiatry 2002 Apr;180:327-30.
  17. Harris B, Fung H, Johns S, Kologlu M, Bhatti R, McGregor AM, et al. Transient post-partum thyroid dysfunction and postnatal depression. J Affect Disord 1989 Nov-Dec;17(3):243-9.
  18. Negro R, Mangieri T, Coppola L, Presicce G, Casavola EC, Gismondi R, et al. Levothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted reproduction technologies: a prospective study. Hum Reprod 2005 Jun;20(6):1529-33.
  19. Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab 2006 Jul;91(7):2587-91.
  20. Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol 2005 Feb;105(2):239-45.
  21. Ghafoor F, Mansoor M, Malik T, Malik MS, Khan AU, Edwards R, et al. Role of thyroid peroxidase antibodies in the outcome of pregnancy. J Coll Physicians Surg Pak 2006 Jul;16(7):468-71.
  22. Abbassi-Ghanavati M, Casey BM, Spong CY, McIntire DD, Halvorson LM ,Cunningham FG. Pregnancy outcomes in women with thyroid peroxidase antibodies. Obstet Gynecol 2010 Aug;116(2 Pt 1):381-6.
  23. Soltanghoraee H, Arefi S, Mohammadzadeh A, Taheri A, Zeraati H, Hashemi B, et al. Thyroid autoantibodies in euthyroid women with recurrent abortions and infertility. Iran J Reprod Med 2010;8(4):153-6.
  24. Bahrami Sharif M, Hosseini M. [Evaluation of antithyroid antibodies in aborting people from obstetrics clinic of Mahdieh Hospital at Shaheed Beheshti University] [Article in Persian]. Sci J Hamadan Univ Med Sci 2009;16(2):27-32.