Profile and feto-maternal outcomes of pregnant women with thyroid dysfunction: a prospective study from South India

摘要

Background: There is an increasing trend in the occurrence of thyroid disorders in pregnant women. Hyperthyroidism occurs in 0.2%-0.3% and can cause foetal loss, growth retardation, pre-eclampsia, and preterm delivery. Subclinical hyperthyroidism is found in 1.5 to 1.7% but has not been associated with adverse outcomes. Incidence of overt hypothyroidism ranges from 0.2 to 2.5% and Subclinical hypothyroidism from 2-7%.There is sparse data regarding this from South India. Methods: This was an observational, hospital based study. 1000 inpatients JSS Hospital, Mysore between November 2011 to July 2013 were studied. Included were inpatients of antenatal ward irrespective of age, parity and their gestational age. Excluded were unbooked cases in obstetric emergencies or cases in active labour. TSH estimation was done for all. If abnormal, T3 and T4 were done. Results: With respect to thyroid status 816 (81.6%) were euthyroid, 44 (4.4%) hypothyroid, 126 (12.6%) subclinical hypothyroidism and 14 (1.4%) were hyperthyroid. 53 (5.3%) had irregular cycles 57 (5.7%) had diabetes, 98 (9.8%) hypertension. 11.4% had diabetes in hypothyroid state had 5.8% had diabetes in euthyroid state. Hypertension in hypothyroid state was 5 out of 44 (11.4%), in those with subclinical hypothyroid state it was 13 out of 126 (10.3%) and euthyroid state was 9.8%. Significantly more patients in hypothyroid state needed cesarean section. The fetal anomalies detected were 4 cases of ventriculomegaly, 2 cases of hydrocephalus, 3 spina bifida, 4 cases of renal anomalies of which 1 was renal agenesis and 3 were polycystic kidneys. Conclusions: This study showed significant association between uncontrolled hypothyroidism and adverse fetomaternal outcome. Abnormal thyroid status was significantly associated with hypertension, diabetes, anaemia and fetal anomalies.