Impact of TSH during the first trimester of pregnancy on obstetric and fetal complications: Usefulness of 2.5 mIU/L cut-off value

Abstract

Objective

An association of pregnancy outcomes with subclinical hypothyroidism has been reported, however there still exists a strong controversy regarding whether subclinical hypothyroidism ought to be dealt with or not. The objective of the study was to evaluate the association of fetal-maternal complications with first trimester maternal TSH values.

Design

A retrospective study in a single tertiary care hospital was performed.

Patients

1981 pregnant women were studied during 2012.

Measurements

Thyrotropin (TSH) universal screening was performed between weeks 9-12 of gestation. Outcomes included fetal-maternal complications and newborn health parameters.

Results

Median TSH was 1.72 (0.99-2.61) mIU/L. The incidence of perinatal loss, miscarriage and stillbirth was 7.2%, 5.9% and 1.1% respectively. Median TSH of women with and without miscarriage was 1.97 (1.29-3.28) vs. 1.71 (0.96-2.58) mIU/L (p=0.009). Incidence of preeclampsia was 3.2%; TSH in these women was 2.10 (1.40-2.74) vs. 1.71 (0.98-2.59) mIU/L in those without (p=0.027). TSH in women with dystocia in labour was 1.76 (1.00-2.53) vs. 1.68 (0.94-2.59) mIU/L in those who gave birth with normal progression (p=0.044). Women with TSH 2.5-5.1 mIU/L had a higher risk of perinatal loss [OR 1.589 (1.085-2.329)], miscarriage [OR 1.702 (1.126-2.572)] and premature birth [OR 1.39 (1.013-1.876)], adjusted by mother's age. There was no association with the other outcomes analyzed.

Conclusions

There is a positive association between maternal TSH in the ​​first trimester of pregnancy and the incidence of perinatal loss and miscarriage. The TSH cut-off value of 2.5 mIU/L identified women with higher adverse pregnancy outcomes.

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