Document Type : Research Article
Authors
- Negin Rezavand 1
- Somayeh Darvishi 1
- Maryam Hematti 2
- Mansour Rezaei 3
- Houshang Nemati 4
- Seyed Mohammad Saleh Seyedzadeh 5
- Alireza Kamravamanesh 6
- Saydeh Saba Seyedzadeh 7
- Mastaneh Kamravamanesh 8
1 Department of Obstetrics and Gynecology, Clinical Research Development Center of Imam Reza Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
2 Department of Statistics, Clinical Research Development Center of Imam Reza Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
3 Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
4 Department of Molecular Medicine Fertility and Infertility Research Center, Health Technology Institute, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
5 General Practitioner, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
6 Department of Laboratory Sciences, School of Paramedical, Kermanshah University of Medical Sciences, Kermanshah, Iran
7 Faculty of Science, McMaster University, Hamilton, Ontario, Canada
8 Department of Reproductive Health, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
Abstract
Background: Endocrine disorders, such as hypothyroidism, can impact fetal growth and development. The significance and necessity of fetal screening before birth are critical for the prevention of congenital disabilities. The present study aimed to evaluate the association between thyroid hormones, specifically T3, T4, FT3, FT4, TSH, Anti TPO, Free BhCG, B-MOM, P-MOM, and NT-MOM, and the risk of screening tests conducted during the first trimester of pregnancy in women diagnosed with hypothyroidism.
Methods: This retrospective, case-control study included 82 pregnant women in their first trimester who were referred for fetal screening tests between 2022 and 2023 at Imam Reza and Motazadi hospitals in Kermanshah, Iran. The case group consisted of 41 pregnant women diagnosed with hypothyroidism and treated with levothyroxine, and the control group comprised 41 pregnant women with normal thyroid function. The assessment of serum levels of T3, free T3, T4, free T4, TSH, and Anti TPO was carried out using the ELISA method, while the first-stage fetal screening tests, including Free BhCG, B-MOM, P-MOM, and NT-MOM, were conducted using the Electro-chemiluminescent (ECL) method. Subsequently, data analysis was conducted using SPSS.
Results: In the case group, the average levels of TSH (P=0.001), TPO (P=0.006), trisomy 21 (P=0.001), and trisomy 13/18 (P=0.001) were significantly higher as compared with the control group. Conversely, in the case group, PAPP-A was significantly lower (P=0.001). However, there was no statistically significant difference between the two groups in terms of mean levels of beta-hCG (P=0.297), B-MoM (P=0.202), and NT-MoM (P=0.221). Furthermore, in the case group treated with levothyroxine, mean serum TSH level was significantly higher in the screen positive and medium risk groups of Down syndrome (DS) as compared with the negative screen group (P=0.014).
Conclusion: Our results indicated that it is important to promptly identify pregnant women with hypothyroidism and ensure that timely screening tests for fetal health are carried out as a mandatory practice.
Highlights
Negin Rezavand: (Google Scholar), (PubMed)
Mastaneh Kamravamanesh: (Google Scholar), (PubMed)
How to Cite: Rezavand N, Darvishi S, Hematti M, Rezaei M, Nemati H, Seyedzadeh SMS, Kamravamanesh AR, Seyedzadeh SS, Kamravamanesh M. Association between Thyroid Hormones and the Risk Level of Screening Tests in the First Trimester of Pregnancy in Hypothyroid Women. Women. Health. Bull. 2024;11(1):57-63. doi: 10.30476/WHB.2024.100645.1258.
Keywords
- Eng L, Lam L. Thyroid function during the fetal and neonatal periods. Neoreviews,2020, 21(1):e30-e36. doi: 10.1542/neo.21-1-e30. PubMed PMID: 31894080. ##
- Vulsma T, Gons MH, de Vijlder JJ. Maternal-fetal transfer of thyroxine in congenital hypothyroidism due to a total organification defect or thyroid agenesis. N Engl J Med. 1989, 321(1):13-6. doi: 10.1056/NEJM198907063210103. PubMed PMID: 2733742. ##
- Donaldson M, Jones J. Optimising outcome in congenital hypothyroidism; current opinions on best practice in initial assessment and subsequent management. J Clin Res Pediatr Endocrinol. 2013;5(Suppl 1):13-22. doi: 10.4274/jcrpe.849. PubMed PMID: 23154163; PubMed Central PMCID: PMC3608009. ##
- Nessa A, Tabassum S, Akther T, Sultana N, Selim S. Rubella Antibody Prevalence and Immunogenicity of Single Dose Rubella Vaccine Among 16 25 Years Girls from Bangladesh. Bangladesh Medical Research Council Bulletin. 2016;42(2):84-89. doi: 10.3329/BMRCB.V42I2.32052. ##
- Sullivan SA. Hypothyroidism in pregnancy. Clin Obstet Gynecol. 2019;62(2):308-319. doi: 10.1097/GRF.0000000000000432. PubMed PMID: 30985406. ##
- Cignini P, Cafà EV, Giorlandino C, Capriglione S, Spata A, Dugo N. Thyroid physiology and common diseases in pregnancy: review of literature. J Prenat Med. 2012;6(4):64-71. PubMed PMID: 23272277; PubMed Central PMCID: PMC3530964. ##
- Martínez M, Soldevila B, Lucas A, Velasco I, Vila L, Puig-Domingo M. Hypothyroidism during pregnancy and its association to perinatal and obstetric morbidity: a review. Endocrinol Diabetes Nutr. 2018;65(2):107-113. doi: 10.1016/j.endinu.2017.11.009. PubMed PMID: 29396214. ##
- Ong GS, Hadlow NC, Brown SJ, Lim EM, Walsh JP. Does the thyroid-stimulating hormone measured concurrently with first-trimester biochemical screening tests predict adverse pregnancy outcomes occurring after 20 weeks gestation? J Clin Endocrinol Metab. 2014;99(12):E2668-E72. doi: 10.1210/jc.2014-1918. PubMed PMID: 25226292. ##
- Hackshaw AK, Wald NJ. Assessment of the value of reporting partial screening results in prenatal screening for Down syndrome. Prenat Diagn. 2001;21(9):737-40. doi: 10.1002/pd.132. PubMed PMID: 11559909. ##
- Zhang B, Lu BY, Yu B, Zheng FX, Zhou Q, Chen YP, et al. Noninvasive prenatal screening for fetal common sex chromosome aneuploidies from maternal blood. J Int Med Res. 2017;45(2):621-630. doi: 10.1177/0300060517695008. PubMed PMID: 28357876; PubMed Central PMCID: PMC5536640. ##
- Zhu Y, Lu S, Bian X, Wang H, Zhu B, Wang H, et al. A multicenter study of fetal chromosomal abnormalities in Chinese women of advanced maternal age. Taiwan J Obstet Gynecol. 2016;55(3):379-84. doi: 10.1016/j.tjog.2016.01.002. PubMed PMID: 27343319. ##
- Smith-Lin C, Wang C, Hanchate A, Connors P, Yarrington CD. 250: Disparities in cell-free fetal DNA aneuploidy screening uptake in an urban safety net hospital. American Journal of Obstetrics & Gynecology. 2018;218(1):S161-S162. doi: 10.1016/j.ajog.2017.10.178. ##
- Ainsworth AJ, Holman MA, Codsi E, Wick M . Use of genetic testing after abnormal screening ultrasound: A Descriptive cohort study. Gynecol Obstet Invest. 2018;83(5):466-470. doi: 10.1159/000484242. PubMed PMID: 29156453. ##
- Manerkar S, Gohil J, Mondkar J. Impact of maternal thyroid disorders on maternal and neonatal outcomes in women delivering after 34 weeks of gestation. Indian Journal of Child Health. 2019;6(2):301-304. doi: 10.32677/IJCH.2019.v06.i06.010. ##
- Fallatah AM, Hasanain A, Babatin H, Nassibi KM, Thigah S, Abduljabbar HS. Pregnancy outcomes among obese pregnant women with hypothyroidism: medical record review of a single tertiary center in Saudi Arabia. Cureus. 2020;12(2):e6938. doi: 10.7759/cureus.6938. PubMed PMID: 32190490; PubMed Central PMCID: PMC7067361. ##
- Villanger GD, Ystrom E, Engel SM, Longnecker MP, Pettersen R, Rowe AD, et al. Neonatal thyroid‐stimulating hormone and association with attention‐deficit/hyperactivity disorder. Paediatr Perinat Epidemiol. 2020;34(5):590-596. doi: 10.1111/ppe.12643. PubMed PMID: 32072662; PubMed Central PMCID: PMC7431377. ##
- Tosun G, Kose S, İşbilen Başok B, Altunyurt S. First-trimester placental function in levothyroxine-using pregnant women: a case-control study. Gynecol Endocrinol. 2020;36(3):233-237. doi: 10.1080/09513590.2019.1708317. PubMed PMID: 31888411. ##
- Liu MY, Lee CT, Lee NC, Tung YC, Chien YH, Hwu WL, et al. Thyroid disorders in Taiwanese children with Down syndrome: the experience of a single medical center. J Formos Med Assoc. 2020;119(1):345-349. doi: 10.1016/j.jfma.2019.06.003. PubMed PMID: 31255418. ##
- Drover SS, Villanger GD, Aase H, Skogheim TS, Longnecker MP, Zoeller RT, et al. Maternal Thyroid Function During Pregnancy or Neonatal Thyroid Function and Attention Deficit Hyperactivity Disorder: A Systematic Review. 2019;30(1):130-144. doi: 10.1097/EDE.0000000000000937. PubMed PMID: 30299402; PubMed Central PMCID: PMC6359926. ##
- Alemu A, Terefe B, Abebe M, Biadgo B. Thyroid hormone dysfunction during pregnancy: A review. Int J Reprod Biomed. 2016;14(11):677-686. PubMed PMID: 27981252; PubMed Central PMCID: PMC5153572. ##