Maternal thyrotrophin in euthyroid women is related to meconium stained amniotic fluid in women who deliver at or over 41 weeks of gestation

Background Maternal thyroid dysfunction is of known influence on pregnancies in the preterm period. However little is known about its effect on term and post term pregnancies. Meconium stained amniotic fluid (MSAF) is known to occur preferentially in (post)term pregnancies. Aims To assess a possible independent relation between maternal thyroid function and MSAF.Study design and subjects1051 women, in whom thyroid function was assessed at each trimester, were followed prospectively (delivery ≥ 37 weeks). We compared the difference in mean TSH and FT4 between women with (152) and without (899) MSAF using one way ANOVA. Thyroid function was assessed in subgroups regarding gestational age. Finally we performed multiple logistic regression analysis with MSAF as dependent variable and TSH as independent variable adjusting for various confounders. Results Maternal thyroid function was not associated with the incidence of MSAF when analysing all deliveries ≥ 37 weeks. However, in the “at-risk” group for MSAF (> 41 weeks), multiple logistic regression showed an independent relation between MSAF and TSH (O.R.: 1.61, 95% CI: 1.10–2.43). Conclusions The present study shows that in women delivering ≥ 41 weeks of gestation, higher TSH is independently related to MSAF

Mode of delivery following successful external cephalic version: Comparison with spontaneous cephalic presentations at delivery

Objective To compare the obstetric outcomes of pregnant women after successful external cephalic version (ECV) (cases) with a large group of pregnant women with a spontaneously occurring cephalic fetal position at delivery (controls). Methods We conducted a retrospective matched cohort study in a teaching hospital in the Netherlands. Delivery outcomes of women with a successful ECV were compared with those of women with spontaneously occurring cephalic presentations, controlling for maternal age, parity, gestational age at delivery, and onset of labour (spontaneous or induced). Exclusion criteria were a history of Caesarean section, delivery at < 35 weeks, and elective Caesarean section. The primary outcome was the prevalence of Caesarean section and instrumental delivery in both groups; secondary outcomes were the characteristics of cases requiring intervention such as Caesarean section or instrumental delivery. Results Women who had a successful ECV had a significantly higher Caesarean section rate than the women in the control group (33/220 [15%] vs. 62/1030 [6.0 %]; P < 0. 001). There was no difference in the incidence of instrumental delivery (20/220 [9.1%] vs. 103/1030 [10%]). Comparison of characteristics of women in the cases group showed that nulliparity, induction of labour, and occiput posterior presentation were associated with Caesarean section and instrumental deliveries. Conclusion:  Compared with delivery of spontaneous cephalic presentations, delivery of cephalic presenting babies following successful ECV is associated with an increased rate of Caesarean section, especially in nulliparous women and women whose labour is induced

High thyrotrophin levels at end term increase the risk of breech presentation

International audienceAbstract Objective. To study the relationship between maternal TSH and breech presentation at term. Design. Combined data sets of two prospective studies to obtain adequate epidemiological power. Patients: 1058 healthy pregnant women (58 breech, 1000 cephalic) and 131 women who presented in breech at an obstetrical outpatient clinic. Measurements: Maternal thyroid parameters (TSH, FT4, TPO-Ab) and fetal presentation were assessed in both groups between 35-38 weeks gestation. Power calculations suggested that at least 148 breech cases were required. Results. The characteristics of the women in breech in both samples were similar. Women in breech (n=58+131) had significantly higher TSH (but not FT4) than those (n=1000) with cephalic presentation (Mann-Whitney U, p = 0.003). Different cut-offs were used to define high TSH in the 916 TPO-Ab negative women with cephalic presentation: the 90th, 95th and 97.5th percentiles were 2.4mIU/l (n=149), 2.7 mIU/l (n=77) and 3.2 mIU/l (n=37). The prevalence rates of breech presentation in these women were all higher compared to the prevalence of breech in women below these cut-offs (df=1, p < 0.01). The R.R. of the 149 women with a TSH > 90th percentile (> 2.4 mIU/l) to present in breech was 1.82 (95% CI: 1.30 - 2.56). Conclusions. Women with high TSH at end term are at risk for breech presentation. Substantial evidence for a relation between breech presentation and neurodevelopmental delay exists. Since high TSH during gestation has also been linked to poor neurodevelopment, the relation between breech presentation and poor neurodevelopment might be thyroid-related. Key words: thyrotrophin, breech presentation, neurodevelopmen

Neonatal thyroid screening results are related to gestational maternal thyroid function

Objective To study the relationship between maternal thyroid function at each pregnancy trimester and neonatal screening results. Background Overt maternal thyroid dysfunction during gestation is associated with poor neonatal thyroid function. However, research on the relationship between suboptimal maternal thyroid function (assessed at three trimesters) and neonatal thyroid screening outcome is scarce. Design/Patients Prospective follow-up study during three trimesters of gestation in 886 Dutch Caucasian healthy pregnant women followed from 12-week gestation until term delivery (&gt;37 weeks) and their neonates. Measurements The relation between neonatal data from the Congenital Hypothyroidism (CH) screening and maternal thyroid determinants [TSH, FT4 and thyroid peroxidase (TPO)-Ab] assessed at 12-, 24- and 36-week gestation. Results Boys have lower screening TT4 levels and their mothers have higher TSH levels at 24- and 36-week gestation. Higher maternal TSH levels (&gt;97Æ5th percentile, as defined in 810 women without TPO-Ab at 12 weeks) at one or more times during pregnancy (O.R: 2Æ26, 95% CI: 1Æ20–4Æ29) and lower gestational age (O.R: 1Æ22, 95% CI: 1Æ05–1Æ41) are independently related to lower screening TT4 levels. Conclusions Maternal thyroid function during gestation is related to neonatal TT4 at screening. The finding of both lower neonatal TT4 levels in boys and higher TSH levels in mothers carrying boys is worthy of further investigation, as both observations may be meaningfully related

Neonatal thyroid screening results are related to gestational maternal thyroid function

Objective To study the relationship between maternal thyroid function at each pregnancy trimester and neonatal screening results. Background Overt maternal thyroid dysfunction during gestation is associated with poor neonatal thyroid function. However, research on the relationship between suboptimal maternal thyroid function (assessed at three trimesters) and neonatal thyroid screening outcome is scarce. Design/Patients Prospective follow-up study during three trimesters of gestation in 886 Dutch Caucasian healthy pregnant women followed from 12-week gestation until term delivery (>37 weeks) and their neonates. Measurements The relation between neonatal data from the Congenital Hypothyroidism (CH) screening and maternal thyroid determinants [TSH, FT4 and thyroid peroxidase (TPO)-Ab] assessed at 12-, 24- and 36-week gestation. Results Boys have lower screening TT4 levels and their mothers have higher TSH levels at 24- and 36-week gestation. Higher maternal TSH levels (>97Æ5th percentile, as defined in 810 women without TPO-Ab at 12 weeks) at one or more times during pregnancy (O.R: 2Æ26, 95% CI: 1Æ20–4Æ29) and lower gestational age (O.R: 1Æ22, 95% CI: 1Æ05–1Æ41) are independently related to lower screening TT4 levels. Conclusions Maternal thyroid function during gestation is related to neonatal TT4 at screening. The finding of both lower neonatal TT4 levels in boys and higher TSH levels in mothers carrying boys is worthy of further investigation, as both observations may be meaningfully related

Maternal thyrotropin is independently related to Small for Gestational Age neonates at term

Objective Small for gestational age (SGA) newborns constitute still a major cause of perinatal morbidity and mortality. Overt thyroid disease is a known cause of preterm birth and low birthweight but in its untreated condition it is rare today. In this study, we investigated the possible relation between maternal thyroid function assessed in euthyroid women at each trimester and the incidence of term born SGA neonates. Design A prospective cohort study was performed. Patients Thyroid function was assessed at 12, 24 and 36 weeks gestation in 1051 healthy Caucasian women who delivered at ≥37 weeks gestation. Measurements One-way anova was used to compare mean TSH and FT4 levels between women with SGA neonates and controls. Multiple logistic regression analysis was performed to adjust for known risk factors of SGA. Results Seventy (6·7%) SGA neonates were identified and they were significantly more often born to women with a TSH ≥ 97·5th at first and third trimester. Multiple logistic regression analysis showed that smoking (OR: 4·4, 95% CI: 2·49–7·64), pre-eclampsia (OR: 2·8, 95% CI: 1·19–6·78) and TSH ≥ 97·5th percentile (OR 3·3, 95% CI 1·39–7·53) were significantly related to SGA. Maternal FT4 levels and TPO-Ab status were not associated with SGA offspring. Conclusions Our data show that TSH levels in the upper range of the reference interval at different trimesters (3·0–3·29 mIU/l) are independently related to an increased risk of delivering SGA neonates at term