ESPE Abstracts

Introduction: Thyroid disorders are the second commonest endocrine dysfunctions encounter in pregnancy after Diabetes. These include overt hypothyroidism, overt hyperthyroidism, subclinical hypothyroidism and subclinical hyperthyroidism. Pregnancy has profound impact on the thyroid gland and thyroid functions (TF). Failure to adapt to these physiological changes result in abnormal TF and cause adverse foetal and neonatal outcomes like miscarriages, placental abruption, preterm delivery, low birth weight <2500g(LBW), neonatal jaundice, respiratory distress and abnormal thyroid functions.

Objective: To compare foetal and neonatal outcome of pregnant women with TD and pregnant women with normal thyroid function test(TFT).

Method: Prospective analytical cohort study conducted in De Soysa maternity hospital in Sri Lanka from January 2018 to January 2021. Included pregnant women with newly diagnosed or existing hypothyroidism(n=186) and hyperthyroidism(n=38) on treatment. Foetal and neonatal outcomes compared with pregnant women with normal TFT (n=186). Trimester specific reference range for TFT as per American Thyroid Association. Occurrence of foetal and neonatal out comes recorded in antenatal and postnatal follow up.

Results: 82% (n=152/186) had overt hypothyroidism and 12% (n=34/186) had subclinical hypothyroidism. 79% (n=30/38) had overt hyperthyroidism and 21%(n=8/38) had subclinical hyperthyroidism. In hypothyroidism group, pregnancy complicated with gestational diabetes 7.5%(n=14/186), pre-eclampsia 10%(n=19/186), maternal anaemia 6% (n=11/186). Hyperthyroidism group, gestational diabetes 2.5%(n=1/38), preeclampsia 15.7% (n=6/38), anaemia 2.5%(n=1/38). In control group, gestational diabetes 2.5%(n=5/186), preeclampsia 3%(n=6/186), anaemia 1.5%(n=3/186). Among hypothyroid group pregnancy complicated with miscarriage 3.7%(n=7/186), placental abruption 1%(n=2/186), preterm delivery 5%(n=9/186). hyperthyroid group miscarriage 10.5%(n=4/38), preterm delivery 10.5%(n=4/38). In control group, miscarriage 0.5% (n=1/186), preterm delivery 6%(n=11/186). Placental abruption not seen among hyperthyroidism and control groups. Neonates born to hypothyroid women had LBW 11%(n=20/186), jaundice 18%(n=33/186), respiratory distress 7%(n=13/186). Neonates of hyperthyroid women, had LBW 16%(n=6/38), respiratory distress 5%(n=2/38), jaundice 16%(n=6/38). In control group, LBW 9%(n=17/186), Jaundice 15% (n=28/186), respiratory distress 4%(n=8/186). Two neonates (1%) in hypothyroidism group diagnosed with congenital hypothyroidism. Two neonates (5%) from hyperthyroidism group had abnormal TFT at birth which improved within 3 weeks without any interventions. Women with hypothyroidism had majority of maternal, foetal and neonatal complications. Women with hyperthyroidism had highest occurrence of miscarriage and LBW.

Conclusion: Our study concludes that occurrence of adverse outcomes comparatively higher among women with TD. It is important to create awareness and to implement TFT as routine antenatal screening.