Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis

Spyridoula Maraka, Naykky M Singh Ospina, Derek T. O'Keeffe, Ana E. Espinosa De Ycaza, Michael R. Gionfriddo, Patricia J. Erwin, Charles C. Coddington, Marius N. Stan, Mohammad H Murad, Victor Manuel Montori

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

Background: The impact of subclinical hypothyroidism (SCH) and of levothyroxine replacement in pregnant women with SCH is unclear. The aims of this study were to assess (i) the impact of SCH during pregnancy on maternal and neonatal outcomes, and (ii) the effect of levothyroxine replacement therapy in these patients. Methods: Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, the Cochrane Controlled Trials Register, Ovid EMBASE, Web of Science, and Scopus were searched from inception to January 2015. Randomized trials and cohort studies of pregnant women with SCH that examined adverse pregnancy and neonatal outcomes were included. Reviewers extracted data and assessed methodological quality in duplicate. Eighteen cohort studies at low-to-moderate risk of bias were included. Compared with euthyroid pregnant women, pregnant women with SCH were at higher risk for pregnancy loss (relative risk [RR] 2.01 [confidence interval (CI) 1.66-2.44]), placental abruption (RR 2.14 [CI 1.23-3.70]), premature rupture of membranes (RR 1.43 [CI 1.04-1.95]), and neonatal death (RR 2.58 [CI 1.41-4.73]). One study at high risk of bias compared pregnant women with SCH who received levothyroxine to those who did not and found no significant decrease in the rate of pregnancy loss, preterm delivery, gestational hypertension, low birth weight, or low Apgar score. Conclusions: SCH during pregnancy is associated with multiple adverse maternal and neonatal outcomes. The value of levothyroxine therapy in preventing these adverse outcomes remains uncertain.

Original languageEnglish (US)
Pages (from-to)580-590
Number of pages11
JournalThyroid
Volume26
Issue number4
DOIs
StatePublished - Apr 1 2016

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Hypothyroidism
Meta-Analysis
Pregnancy
Pregnant Women
Thyroxine
Confidence Intervals
MEDLINE
Cohort Studies
Mothers
Abruptio Placentae
High-Risk Pregnancy
Pregnancy Induced Hypertension
Apgar Score
Low Birth Weight Infant
Pregnancy Rate
Pregnancy Outcome
Rupture
Membranes
Therapeutics

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Maraka, S., Ospina, N. M. S., O'Keeffe, D. T., Espinosa De Ycaza, A. E., Gionfriddo, M. R., Erwin, P. J., ... Montori, V. M. (2016). Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis. Thyroid, 26(4), 580-590. https://doi.org/10.1089/thy.2015.0418

Subclinical Hypothyroidism in Pregnancy : A Systematic Review and Meta-Analysis. / Maraka, Spyridoula; Ospina, Naykky M Singh; O'Keeffe, Derek T.; Espinosa De Ycaza, Ana E.; Gionfriddo, Michael R.; Erwin, Patricia J.; Coddington, Charles C.; Stan, Marius N.; Murad, Mohammad H; Montori, Victor Manuel.

In: Thyroid, Vol. 26, No. 4, 01.04.2016, p. 580-590.

Research output: Contribution to journalArticle

Maraka, S, Ospina, NMS, O'Keeffe, DT, Espinosa De Ycaza, AE, Gionfriddo, MR, Erwin, PJ, Coddington, CC, Stan, MN, Murad, MH & Montori, VM 2016, 'Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis', Thyroid, vol. 26, no. 4, pp. 580-590. https://doi.org/10.1089/thy.2015.0418
Maraka S, Ospina NMS, O'Keeffe DT, Espinosa De Ycaza AE, Gionfriddo MR, Erwin PJ et al. Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis. Thyroid. 2016 Apr 1;26(4):580-590. https://doi.org/10.1089/thy.2015.0418
Maraka, Spyridoula ; Ospina, Naykky M Singh ; O'Keeffe, Derek T. ; Espinosa De Ycaza, Ana E. ; Gionfriddo, Michael R. ; Erwin, Patricia J. ; Coddington, Charles C. ; Stan, Marius N. ; Murad, Mohammad H ; Montori, Victor Manuel. / Subclinical Hypothyroidism in Pregnancy : A Systematic Review and Meta-Analysis. In: Thyroid. 2016 ; Vol. 26, No. 4. pp. 580-590.
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abstract = "Background: The impact of subclinical hypothyroidism (SCH) and of levothyroxine replacement in pregnant women with SCH is unclear. The aims of this study were to assess (i) the impact of SCH during pregnancy on maternal and neonatal outcomes, and (ii) the effect of levothyroxine replacement therapy in these patients. Methods: Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, the Cochrane Controlled Trials Register, Ovid EMBASE, Web of Science, and Scopus were searched from inception to January 2015. Randomized trials and cohort studies of pregnant women with SCH that examined adverse pregnancy and neonatal outcomes were included. Reviewers extracted data and assessed methodological quality in duplicate. Eighteen cohort studies at low-to-moderate risk of bias were included. Compared with euthyroid pregnant women, pregnant women with SCH were at higher risk for pregnancy loss (relative risk [RR] 2.01 [confidence interval (CI) 1.66-2.44]), placental abruption (RR 2.14 [CI 1.23-3.70]), premature rupture of membranes (RR 1.43 [CI 1.04-1.95]), and neonatal death (RR 2.58 [CI 1.41-4.73]). One study at high risk of bias compared pregnant women with SCH who received levothyroxine to those who did not and found no significant decrease in the rate of pregnancy loss, preterm delivery, gestational hypertension, low birth weight, or low Apgar score. Conclusions: SCH during pregnancy is associated with multiple adverse maternal and neonatal outcomes. The value of levothyroxine therapy in preventing these adverse outcomes remains uncertain.",
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AU - Espinosa De Ycaza, Ana E.

AU - Gionfriddo, Michael R.

AU - Erwin, Patricia J.

AU - Coddington, Charles C.

AU - Stan, Marius N.

AU - Murad, Mohammad H

AU - Montori, Victor Manuel

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N2 - Background: The impact of subclinical hypothyroidism (SCH) and of levothyroxine replacement in pregnant women with SCH is unclear. The aims of this study were to assess (i) the impact of SCH during pregnancy on maternal and neonatal outcomes, and (ii) the effect of levothyroxine replacement therapy in these patients. Methods: Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, the Cochrane Controlled Trials Register, Ovid EMBASE, Web of Science, and Scopus were searched from inception to January 2015. Randomized trials and cohort studies of pregnant women with SCH that examined adverse pregnancy and neonatal outcomes were included. Reviewers extracted data and assessed methodological quality in duplicate. Eighteen cohort studies at low-to-moderate risk of bias were included. Compared with euthyroid pregnant women, pregnant women with SCH were at higher risk for pregnancy loss (relative risk [RR] 2.01 [confidence interval (CI) 1.66-2.44]), placental abruption (RR 2.14 [CI 1.23-3.70]), premature rupture of membranes (RR 1.43 [CI 1.04-1.95]), and neonatal death (RR 2.58 [CI 1.41-4.73]). One study at high risk of bias compared pregnant women with SCH who received levothyroxine to those who did not and found no significant decrease in the rate of pregnancy loss, preterm delivery, gestational hypertension, low birth weight, or low Apgar score. Conclusions: SCH during pregnancy is associated with multiple adverse maternal and neonatal outcomes. The value of levothyroxine therapy in preventing these adverse outcomes remains uncertain.

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