Thyroid diseases and adverse pregnancy outcomes in a contemporary US cohort.
Thyroid diseases and adverse pregnancy outcomes in a contemporary US cohort.
CONCLUSIONS: Thyroid diseases were associated with obstetrical, labor, and delivery complications. Although we lacked information on treatment during pregnancy, these nationwide data suggest either that there is a need for better thyroid disease management during pregnancy or that there may be an intrinsic aspect of thyroid disease that causes poor pregnancy outcomes. CONTEXT: Thyroid diseases are inconsistently reported to increase risk for pregnancy complications. DESIGN, SETTING, AND PARTICIPANTS: We analyzed singleton pregnancies (N = 223 512) from a retrospective US cohort, the Consortium on Safe Labor (2002-2008). Thyroid diseases and outcomes were derived from electronic medical records. Multivariable logistic regression with generalized estimating equations estimated adjusted odds ratios (ORs) with 99% confidence intervals (99% CI). MAIN OUTCOME MEASURES: Hypertensive diseases, diabetes, preterm birth, cesarean sections, inductions, and intensive care unit (ICU) admissions were analyzed. OBJECTIVE: The objective of this study was to study pregnancy complications associated with common and uncommon thyroid diseases. RESULTS: Primary hypothyroidism was associated with increased odds of preeclampsia (OR = 1.47, 99% CI = 1.20-1.81), superimposed preeclampsia (OR = 2.25, 99% CI = 1.53-3.29), gestational diabetes (OR = 1.57, 99% CI = 1.33-1.86), preterm birth (OR = 1.34, 99% CI = 1.17-1.53), induction (OR = 1.15, 99% CI = 1.04-1.28), cesarean section (prelabor, OR = 1.31, 99% CI = 1.11-1.54; after spontaneous labor OR = 1.38, 99% CI = 1.14-1.66), and ICU admission (OR = 2.08, 99% CI = 1.04-4.15). Iatrogenic hypothyroidism was associated with increased odds of placental abruption (OR = 2.89, 99% CI = 1.14-7.36), breech presentation (OR = 2.09, 99% CI = 1.07-4.07), and cesarean section after spontaneous labor (OR = 2.05, 99% CI = 1.01-4.16). Hyperthyroidism was associated with increased odds of preeclampsia (OR = 1.78, 99% CI = 1.08-2.94), superimposed preeclampsia (OR = 3.64, 99% CI = 1.82-7.29), preterm birth (OR = 1.81, 99% CI = 1.32-2.49), induction (OR = 1.40, 99% CI = 1.06-1.86), and ICU admission (OR = 3.70, 99% CI = 1.16-11.80).
0021-972X
*Hyperthyroidism/pp [Physiopathology]
*Hypothyroidism/pp [Physiopathology]
*Iatrogenic Disease
*Pregnancy Complications/pp [Physiopathology]
Abruptio Placentae/ep [Epidemiology]
Abruptio Placentae/et [Etiology]
Adult
Breech Presentation/ep [Epidemiology]
Breech Presentation/et [Etiology]
Cohort Studies
Diabetes, Gestational/ep [Epidemiology]
Diabetes, Gestational/et [Etiology]
Electronic Health Records
Female
Humans
Hyperthyroidism/ep [Epidemiology]
Hypothyroidism/ep [Epidemiology]
Iatrogenic Disease/ep [Epidemiology]
Pre-Eclampsia/ep [Epidemiology]
Pre-Eclampsia/et [Etiology]
Pregnancy
Pregnancy Complications/ep [Epidemiology]
Pregnancy Complications/et [Etiology]
Pregnancy Outcome
Premature Birth/ep [Epidemiology]
Premature Birth/et [Etiology]
Retrospective Studies
Risk
United States/ep [Epidemiology]
Young Adult
MedStar Washington Hospital Center
Obstetrics and Gynecology, Maternal-Fetal Medicine
Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
CONCLUSIONS: Thyroid diseases were associated with obstetrical, labor, and delivery complications. Although we lacked information on treatment during pregnancy, these nationwide data suggest either that there is a need for better thyroid disease management during pregnancy or that there may be an intrinsic aspect of thyroid disease that causes poor pregnancy outcomes. CONTEXT: Thyroid diseases are inconsistently reported to increase risk for pregnancy complications. DESIGN, SETTING, AND PARTICIPANTS: We analyzed singleton pregnancies (N = 223 512) from a retrospective US cohort, the Consortium on Safe Labor (2002-2008). Thyroid diseases and outcomes were derived from electronic medical records. Multivariable logistic regression with generalized estimating equations estimated adjusted odds ratios (ORs) with 99% confidence intervals (99% CI). MAIN OUTCOME MEASURES: Hypertensive diseases, diabetes, preterm birth, cesarean sections, inductions, and intensive care unit (ICU) admissions were analyzed. OBJECTIVE: The objective of this study was to study pregnancy complications associated with common and uncommon thyroid diseases. RESULTS: Primary hypothyroidism was associated with increased odds of preeclampsia (OR = 1.47, 99% CI = 1.20-1.81), superimposed preeclampsia (OR = 2.25, 99% CI = 1.53-3.29), gestational diabetes (OR = 1.57, 99% CI = 1.33-1.86), preterm birth (OR = 1.34, 99% CI = 1.17-1.53), induction (OR = 1.15, 99% CI = 1.04-1.28), cesarean section (prelabor, OR = 1.31, 99% CI = 1.11-1.54; after spontaneous labor OR = 1.38, 99% CI = 1.14-1.66), and ICU admission (OR = 2.08, 99% CI = 1.04-4.15). Iatrogenic hypothyroidism was associated with increased odds of placental abruption (OR = 2.89, 99% CI = 1.14-7.36), breech presentation (OR = 2.09, 99% CI = 1.07-4.07), and cesarean section after spontaneous labor (OR = 2.05, 99% CI = 1.01-4.16). Hyperthyroidism was associated with increased odds of preeclampsia (OR = 1.78, 99% CI = 1.08-2.94), superimposed preeclampsia (OR = 3.64, 99% CI = 1.82-7.29), preterm birth (OR = 1.81, 99% CI = 1.32-2.49), induction (OR = 1.40, 99% CI = 1.06-1.86), and ICU admission (OR = 3.70, 99% CI = 1.16-11.80).
0021-972X
*Hyperthyroidism/pp [Physiopathology]
*Hypothyroidism/pp [Physiopathology]
*Iatrogenic Disease
*Pregnancy Complications/pp [Physiopathology]
Abruptio Placentae/ep [Epidemiology]
Abruptio Placentae/et [Etiology]
Adult
Breech Presentation/ep [Epidemiology]
Breech Presentation/et [Etiology]
Cohort Studies
Diabetes, Gestational/ep [Epidemiology]
Diabetes, Gestational/et [Etiology]
Electronic Health Records
Female
Humans
Hyperthyroidism/ep [Epidemiology]
Hypothyroidism/ep [Epidemiology]
Iatrogenic Disease/ep [Epidemiology]
Pre-Eclampsia/ep [Epidemiology]
Pre-Eclampsia/et [Etiology]
Pregnancy
Pregnancy Complications/ep [Epidemiology]
Pregnancy Complications/et [Etiology]
Pregnancy Outcome
Premature Birth/ep [Epidemiology]
Premature Birth/et [Etiology]
Retrospective Studies
Risk
United States/ep [Epidemiology]
Young Adult
MedStar Washington Hospital Center
Obstetrics and Gynecology, Maternal-Fetal Medicine
Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural