A Prospective Study of Routine Screening of Hypothyroidism in Antenatal Patients and their Outcome with Levothyroxine Treatment

Abstract

Introduction: Pregnancy with hypothyroidism is associated with significant maternal, fetal and neonatal complications. Early diagnosis and treatment can effectively reduce such complications. Aim: To find out the complications that can be prevented or reduced in severity in adequately treated hypothyroid pregnant women. Materials and Methods: Pregnant women attending obstetrics’ OPD upto 20 weeks were screened with serum Thyroid Stimulating Hormone (TSH) and free Thyroxine FT4. Those having Subclinical Hypothyroidism (SCH), Overt Hypothyroidism (OH) and pre pregnant women with hypothyroid were treated with levothyroxine as per consulting with endocrine unit. They were followed up till delivery and any adverse outcomes were documented such as Pregnancy Induced Hypertension (PIH), Pre Eclamptic Toxemia (PET), Abruption, Preterm Premature Rupture Of Membranes (PPROM), Low Birth Weight (LBW), oligohydramnios, Gestational Diabetes Mellitus (GDM), abortion, Intra Uterine Death (IUD), mode of delivery and Neonatal Intensive Care Unit (NICU) admission were compared with similar complications documented among normal pregnant women excluding the treated hypothyroid during a period of one year study. Untreated or late trimester diagnosed hypothyroidism were excluded from study group. Results: Incidence of PIH, GDM, Oligohydramnios, PPROM, NICU admissions and caesarean section were higher among hypothyroid pregnant women though adequately treated than the control pregnant women. But incidence of LBW baby is less and no one had developed PET, Eclampsia or abruption among treated group. Comparing between SCH and OH incidence of PIH is almost equal in both while association of GDM is more in OH. A p-value for PIH, GDM, Oligohydramnios, PPROM developed in hypothyroid pregnant ladies which were calculated by Yates corrected Chi-Square and Fisher’s-exact test from open epic version 3.03a. A p-value is significant (<0.001) for PIH, GDM, PPROM and oligohydramnios but insignificant for LBW. Conclusion: Severe form of PIH (PET and Eclampsia), IUD and Abruptio placentae can be prevented in adequately treated pregnant hypothyroid women and all pregnant women with SCH and OH must screen for GDM even if there is no other risk factors for GDM.

Keywords

• Abruptio placentae
• Overt
• Pregnancy induced hypertension
• Preterm premature rupture of membranes
• Subclinical