Neonatal Effects of Thyroid Diseases in Pregnancy and Approach to The Infant With Increased TSH in A Tertiary Care Hospital In Dhaka
Abstract
Background: Thyroid stimulating hormone (TSH) plays a crucial role in embryonic and fetal development from early pregnancy. Both maternal hypothyroidism and hyperthyroidism can significantly impact fetal and neonatal thyroid function, potentially leading to adverse developmental outcomes.
Objective: The aim of this study is to assist pediatricians, neonatologists, and pediatric endocrinologists with the assessment, diagnosis, and treatment of thyroid function disorders and thyroid diseases in the fetus and baby during pregnancy and the neonatal period.
Methods: This prospective cohort study was nested within a larger investigation conducted in Ashiyan Medical College Hospital, Dhaka, Bangladesh.. Pregnant women were recruited between November 2017 and October 2023. Of 1237 invited participants, 266 pregnant women were enrolled, with 4,26 providing blood samples during their first prenatal visit (approximately week 13). Thyroid function was assessed by measuring TSH, free T3 (fT3), and free T4 (fT4) levels across all trimesters.
Results: Mean TSH levels showed a progressive increase across trimesters (first: 1.31±0.51 mU/L; second: 1.67±0.77 mU/L; third: 2.36±0.58 mU/L). Child loss was significantly associated with elevated maternal TSH levels, with 41% experiencing miscarriage, 37% fetal death, and 22% neonatal death. The relationship between TSH levels and adverse outcomes persisted even within the normal reference range and after adjusting for confounding factors including parity, smoking, diabetes mellitus, and hypertension.
Conclusions: Elevated maternal TSH levels during pregnancy are associated with increased risk of adverse neonatal outcomes, even in women without overt thyroid dysfunction. These findings suggest that maintaining optimal maternal TSH levels throughout pregnancy is crucial for fetal and neonatal well-being, and support considering treatment for women with even mildly elevated TSH levels. Regular thyroid function monitoring during pregnancy may help identify at-risk cases and improve perinatal outcomes.
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References
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