Objective

The aim of the study was to investigate the impact of suppressed serum TSH levels (sTSH) during early pregnancy on maternal and neonatal outcomes.

Methods

In this single-centre, retrospective cohort study 1081 women were screened at 11.8 ± 2.4 weeks of pregnancy for TSH, free T4 (FT4) and TPOAb. Exclusion criteria were twin- and assisted- reproduction pregnancies, women with TSH levels >3.74 mIU/L, severe hyperthyroidism, treated for thyroid dysfunction before or after screening and gestational blood sampling <6 or >16 weeks of pregnancy. The prevalence of adverse pregnancy outcomes was compared between the study group sTSH (TSH: < 0.06 mIU/L; n = 36) and euthyroid controls (TSH: 0.06–3.74 mIU/L; n = 1045), and the impact of sTSH on pregnancy outcomes verified in logistic regression analyses.

Results

Median (IQR) serum TSH level in women with sTSH was 0.03 (0.03–0.03) vs 1.25 (0.81–1.82) mIU/L in controls and FT4 levels 18.0 (14.4–20.3) vs 14.2 (12.9–15.4) pmol/L; both P < 0.001. None of the women with sTSH had thyrotropin receptor antibodies. Compared with controls, the prevalence of TPOAb positivity (TAI) was comparable between groups (5.6% vs 6.6%; P = 0.803). The prevalence of maternal and neonatal pregnancy outcomes was comparable between the study and control group. The logistic regression analyses with corrections for TAI, FT4 and demographic parameters confirmed the absence of an association between sTSH, and the following outcomes: iron deficient anaemia (aORs (95% CI)): 1.41 (0.64-2.99); P = 0.385, gestational diabetes: 1.19 (0.44–2.88); P = 0.713, preterm birth: 1.57 (0.23–6.22);P = 0.574 and low Apgar-1′ score: 0.71 (0.11–2.67); P = 0.657.

Conclusions

Suppressed serum TSH levels during the first to early second trimester of pregnancy were not associated with altered maternal or neonatal outcomes.

中文翻译：

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妊娠早期妊娠抑制的血清 TSH 水平与孕产妇和新生儿结局的改变无关

客观的

该研究的目的是调查妊娠早期血清 TSH 水平 (sTSH) 受到抑制对孕产妇和新生儿结局的影响。

方法

在这项单中心回顾性队列研究中，1081 名女性在怀孕 11.8 ± 2.4 周时接受了 TSH、游离 T4 (FT4) 和 TPOAb 筛查。排除标准为双胎妊娠和辅助生殖妊娠、TSH 水平 >3.74 mIU/L 的女性、严重甲状腺功能亢进、在妊娠 <6 周或 >16 周的筛查和妊娠血液采样之前或之后接受甲状腺功能障碍治疗。比较了研究组 sTSH（TSH：< 0.06 mIU/L；n  = 36）和甲状腺功能正常对照组（TSH：0.06–3.74 mIU/L；n  = 1045）之间不良妊娠结局的发生率，以及 sTSH 对妊娠结局的影响。妊娠结局经逻辑回归分析验证。

结果

患有 sTSH 的女性血清 TSH 水平中位数 (IQR) 为 0.03 (0.03–0.03) vs 对照组 1.25 (0.81–1.82) mIU/L，FT4 水平为 18.0 (14.4–20.3) vs 14.2 (12.9–15.4) pmol/L；两者P < 0.001。患有 sTSH 的女性均没有促甲状腺素受体抗体。与对照组相比，两组间 TPOAb 阳性率 (TAI) 相当（5.6% vs 6.6%；P  = 0.803）。研究组和对照组的孕产妇和新生儿妊娠结局发生率相当。对 TAI、FT4 和人口参数进行校正的逻辑回归分析证实，sTSH 与以下结果之间不存在关联：缺铁性贫血 (aOR (95% CI))：1.41 (0.64-2.99)；P  = 0.385，妊娠糖尿病：1.19（0.44–2.88）；P  = 0.713，早产：1.57（0.23–6.22）；P  = 0.574 和低 Apgar-1′ 分数：0.71 (0.11–2.67)；P  = 0.657。

结论

妊娠早期至中期早期血清 TSH 水平的抑制与孕产妇或新生儿结局的改变无关。