The Impact of Thyroid Disorders on Clinical Pregnancy Outcomes in a Real-World Study Setting

Background: Subclinical hypothyroidism (SCH) and thyroid autoimmunity (TAI) have been associated with poor clinical pregnancy outcomes. However, these outcomes also depend on a number of demographic and obstetric variables. Therefore, the aim of this study was to investigate the impact of thyroid disorders on these outcomes, after adjustment for associated demographic and obstetrical parameters. Methods: This is cross-sectional study including 1521 pregnant women who underwent work-up and follow-up in the Centre Hospitalier Universitaire (CHU) Saint-Pierre, Brussels, and had ongoing pregnancies. Thyroid function (thyrotropin [TSH], free thyroxine [fT4]) and TAI (thyroid peroxidase antibodies) was determined at median (Q1-Q3) 13 (11-17) weeks. Baseline parameters and the prevalence of poor clinical pregnancy outcomes were compared between controls (no TAI and TSH <2.51 mIU/L) and three study groups (isolated TAI [TSH <2.51 mIU/L], SCH1 [TSH 2.51-3.7 mIU/L], SCH2 [TSH >3.7 mIU/L]). The impact of the different thyroid groups and demographic/obstetric independent variables on six poor clinical pregnancy outcomes (preeclampsia, intrauterine growth restriction [IUGR], preterm birth, neonatal intensive care unit [NICU] admission, low birth weight, and macrosomia) was investigated in a logistic regression model. Treatment with thyroid hormone before and during pregnancy and assisted and multiple pregnancies were exclusion criteria. Results: In total, 79 preeclampsias (5.2%), 40 IUGRs (2.6%), 79 preterm births (5.2%), 10 admissions to NICU (0.66%), 74 low birth weights (4.9%), and 94 babies with macrosomia (6.2%) were documented. TAI was independently associated with NICU admission (adjusted odds ratio [aOR] 16.92 confidence interval [CI 3.36-85.29]; p < 0.001) and TSH, as a continuous variable in the whole range, with preeclampsia (aOR 1.97 [CI 1.18-3.31]; p = 0.010). Trends were present for an association between SCH2 and preeclampsia (aOR 16.73 [CI 1.43-196.42]; p = 0.025), and for SCH1with NICU admission and low birth weight (aOR 19.36 [CI 1.18-316.97]; p = 0.038 and 21.38 [CI 1.29-353.39]; p = 0.032, respectively). Conclusions: Pregnant women with TAI had a significantly higher risk of an admission of the baby to the NICU, and SCH tended to be associated with a higher risk of preeclampsia and low birth weight. Other poor clinical pregnancy outcomes were not associated with thyroid disorders, but with demographic and obstetric parameters.