Thyroid diseases and adverse pregnancy outcomes in a contemporary US cohort.

MedStar author(s):
Citation: Journal of Clinical Endocrinology & Metabolism. 98(7):2725-33, 2013 Jul.PMID: 23744409Institution: MedStar Washington Hospital CenterDepartment: Obstetrics and Gynecology, Maternal-Fetal MedicineForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, N.I.H., Extramural | Research Support, N.I.H., IntramuralSubject headings: *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 AdultISSN:
  • 0021-972X
Name of journal: The Journal of clinical endocrinology and metabolismAbstract: 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).All authors: Chen Z, Grewal J, Laughon SK, Mannisto T, Mendola P, Xie YDigital Object Identifier: Date added to catalog: 2014-04-22
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Journal Article MedStar Authors Catalog Article Available 23744409

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).

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