Thyroid Laboratory Testing and Management in Women on Thyroid Replacement Before Pregnancy and Associated Pregnancy Outcomes

Women with hypothyroidism before pregnancy often require an increase in their levothyroxine dosage to maintain a euthyroid state during pregnancy. The objectives of this study were to investigate: (i) the frequency and distribution of thyrotropin (TSH) testing and levothyroxine dosage adjustment by...

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Vydáno v:Thyroid (New York, N.Y.) Ročník 31; číslo 5; s. 841
Hlavní autoři: Lemieux, Patricia, Yamamoto, Jennifer M, Nerenberg, Kara A, Metcalfe, Amy, Chin, Alex, Khurana, Rshmi, Donovan, Lois Elizabeth
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 01.05.2021
Témata:
Adult
Alberta - epidemiology
Dose-Response Relationship, Drug
Female
Gestational Age
Hormone Replacement Therapy - methods
Humans
Hypothyroidism - blood
Hypothyroidism - drug therapy
Infant, Newborn
Intensive Care Units, Neonatal - statistics & numerical data
Practice Patterns, Physicians' - statistics & numerical data
Preconception Care - statistics & numerical data
Pregnancy
Pregnancy Complications - blood
Pregnancy Complications - drug therapy
Pregnancy Outcome - epidemiology
Premature Birth - epidemiology
Retrospective Studies
Thyroid Function Tests - statistics & numerical data
Thyrotropin - blood
Thyroxine - administration & dosage
Alberta
thyroid and pregnancy
pregnancy outcomes
hypothyroidism
overtreatment
pregnancy
thyroid function tests
ISSN:1557-9077, 1557-9077
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Shrnutí:Women with hypothyroidism before pregnancy often require an increase in their levothyroxine dosage to maintain a euthyroid state during pregnancy. The objectives of this study were to investigate: (i) the frequency and distribution of thyrotropin (TSH) testing and levothyroxine dosage adjustment by gestational age, (ii) the magnitude of levothyroxine increase by the underlying etiology of hypothyroidism, and (iii) the relationship of overtreatment or undertreatment during pregnancy with adverse pregnancy outcomes among women using thyroid replacement before pregnancy. A retrospective cohort study of pregnancies in women on thyroid replacement before pregnancy in Alberta, Canada, was performed. Women using thyroid replacement anytime during the two years before pregnancy who delivered between October 2014 and September 2017 were included. Delivery records, physician billing, and laboratory and pharmacy administrative data were linked. Outcomes included characteristics of TSH testing, levothyroxine dosing, and pregnancy outcomes. The frequency and gestational timing of TSH testing and levothyroxine adjustments were calculated. Multiple logistic regression was used to test whether pregnancies with TSH <0.10 mIU/L (overtreatment) or TSH ≥10.00 mIU/L (undertreatment) compared with control pregnancies (TSH 0.10-4.00 mIU/L) were associated with adverse pregnancy and neonatal outcomes. Of the 10,680 deliveries, 8774 (82.2%) underwent TSH testing at least once during pregnancy, at a median gestational age of six weeks. An adjustment of levothyroxine dosage was made for 4321 (43.7%) during pregnancy. TSH in pregnancy below 0.10 mIU/L increased the odds of preterm delivery when compared with control pregnancies (adjusted odds ratio, 2.14 [95% confidence interval 1.51-2.78]). TSH ≥10.00 mIU/L during pregnancy was not associated with any adverse pregnancy or neonatal outcomes in the multivariable analysis. Although most women on thyroid replacement before conception had TSH measured at some point during pregnancy, it is concerning that 17.8% did not. Levothyroxine overtreatment in pregnancy was associated with preterm delivery. These findings suggest that clinicians should be careful to avoid overtreatment with levothyroxine in pregnancy.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1557-9077
1557-9077
DOI:10.1089/thy.2020.0609