The Role Of Maternal Thyroid Status On Pregnancy Outcome For

Mother and Newborn

Oleh
Cut Meurah Yeni
Head of Fetomaternal Division - Department obstetrics and Gynecology
Faculty of Medicine, Universitas Syiah Kuala
 Introduction

Physiology in
INTRODUCTION
Pregnancy

Causes Hyperthyroidism is characterised by high Thyroid disorders can be divided into (sub)clinical
levels of serum thyroxine and hyperthyroidism, (sub)clinical hypothyroidism and/or
Hyperthyroid triiodothyronine, and low levels of thyroid- thyroid autoimmunity.
stimulating hormone.
Hypothyroid
At least 2%–3% of pregnant women are
Effect Maternal affected by thyroid dysfunction.
Thyroid
Hyperthyroidism is found in 0.1–0.4% of
Management pregnant women and is most commonly
caused by Graves’ disease (85 %) (Bahn
Benefit et al., 2011). Graves’ disease in
pregnancy is associated with miscarriage,
Preventive preeclampsia, preterm birth, placental
abruption and fetal hyperthyroidism ✓ Grave disease
Conclusion (Zimmerman, 1999; Earl et al., 2010). ✓ Struma nodosa toxic
✓ Adenoma toxic
Woman- man 5:1 ✓ Thyroiditis
Introduction

Physiology in
Pregnancy
INTRODUCTION
Causes

Hyperthyroid The prevalence of clinical • Hypothyroidism in pregnancy is

hypothyroidism is 0.3–0.5% in associated with miscarriage, placental
Hypothyroid
pregnant women (Abalovich abruption, neonatal intensive care unit
Effect et al., 2007). (NICU) admission and lower
Maternal intelligence scores (Haddow et al.,
Thyroid
Hypothyroidism in women of 1999; Li et al., 2010; van den
Boogaard et al., 2011).
Management reproductive age is most
commonly caused by an
Benefit
autoimmune thyroiditis and
Preventive Hashimoto’s disease
(Abalovich et al., 2007).
Conclusion
Introduction

Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect
Maternal
Thyroid

Management

Benefit

Preventive
Hypothamus-Hypophysis-Thyroid gland

Conclusion
 Introduction

Physiology in
Pregnancy

Causes
During the 10th to 12th week of gestation,
fetal thyrotropin (TSH) appears and the
Hyperthyroid fetal thyroid is capable of concentrating
Hypothyroid iodine and synthesizing iodothyronines.
Effect Maternal
Thyroid The thyroid gland controls rate of
metabolic processes throughout the body
Management
via the production of two hormones
Benefit triiodothyronine and thyroxine (T4). These
Preventive hormones also have key roles in growth
and development, particularly brain
Conclusion
development.
Introduction
Physiology Thyroid Hormone
Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect
Maternal
Thyroid

Management

Benefit

Preventive

Conclusion
Introduction

Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect
Maternal
Thyroid

Management

Benefit
Changes in thyroid physiology during pregnancy. An increase in thyroxine-binding globulin
Preventive (TBG), an increase in thyroxine consumption by the fetus and and an increase in placental type
3 deiodinase expression require an upregulation of thyroid hormone production to maintain
Conclusion adequate thyroid hormone availability. This upregulations is largely mediated via increased
thyroidal stimulation by human chorionic gonadotropin (hCG)
Introduction

Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect
Maternal
Thyroid

Management

Benefit

Preventive

Conclusion
Introduction

Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect
Maternal
Thyroid

Management

Benefit

Preventive

Conclusion
Introduction

Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect
Maternal
Thyroid

Management

Benefit

Preventive

Conclusion
 Introduction

Physiology in Sign and Symptom

Pregnancy

Causes

Sign and
Symptom

Hyperthyroid

Hypothyroid

Effec Maternal
Thyroid

Management

Benefit

Preventive

Conclusion
Introduction

Physiology in
Pregnancy
Sign and Symptom Thyrotoxicosis
Causes

Sign and
Symptom

Hyperthyroid

Hypothyroid

Effect
Maternal
Thyroid

Management

Benefit

Preventive

Conclusion
Introduction

Physiology in
Complications of Hyperthyroidism In Pregnancy
Pregnancy

Causes Increased and recurrent pregnancy loss

Hyperthyroid Preterm delivery
Hypothyroid
Preeclampsia
Fetal Growth Restriction
Effect
Maternal
Fetal thyroid hyperfunction or hypofunction caused by
Thyroid Trab
Management Fetal goiter from excessive antithyroid drug treatment
Neonatal thyrotoxicosis
Benefit
Increased perinatal and maternal mortality risk
Preventive Potential for decreased iQ of offspring because of
Conclusion excessive of antithyroid drugs
Introduction

Physiology in
Complications OF Hyperthyroidism In Pregnancy
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect
Maternal
Thyroid

Management

Benefit

Preventive

Conclusion
Introduction

Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect
Maternal
Thyroid

Management

Benefit

Preventive

Conclusion
Introduction

Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid Clinical hyperthyroidism was significantly associated with fetal distress, whereas subclinical
hyperthyroidism increased the incidence of umbilical cord entanglement in the neonates
Effect
Maternal
Thyroid The most common symptoms of hyperthyroidism are tachycardia, vasospasm, increased basal
metabolism and oxygen consumption, which may be related with fetal anoxia and umbilical
Management cord entanglement

Benefit Study found an increased odd for macrosomia among infants of mothers with isolated
hypothyroxinemia.
Preventive
Maternal hyperthyroidism was associated with an increased risk of hypertensive disorders,
Conclusion which may induce preeclampsia. Furthermore, we also found maternal iodine deficiency was
related to abnormal amniotic fluid and placenta previa.
Introduction

Physiology in
Pregnancy

Causes
We show that both low and high maternal
Hyperthyroid TSH concentrations, particularly in early
pregnancy, are associated with a smaller
Hypothyroid
volume of total grey matter and cortical grey
Effect
matter in children aged 9–12 years
Maternal
Brain imaging parameters with
Thyroid
neurodevelopmental outcomes, including our
Management results with child IQ, associations of maternal
thyroid dysfunction with offspring total grey
Benefit matter and cortex volume might be
particularly relevant for child cognitive
Preventive development.

Conclusion TSH might be a more specific predictor for

total grey matter or cortical grey matter
development than FT4
Introduction
Complication Effect Maternal Thyroid dysfunction
Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect
Maternal
Thyroid

Management

Benefit

Preventive

Conclusion

Effects of thyroid diseases on pregnancy outcomes, Min Zhou, 2019

Introduction
Introduction
Effect Maternal Thyroid to Neonatal
Physiology in
Physiology in
Pregnancy
Pregnancy

Causes Fetal and neonatal Graves' disease → One to 5 percent of neonates born to
Causes
women with Graves' disease have hyperthyroidism due to transplacental transfer
Hyperthyroid
Hyperthyroid of TSH receptor-stimulating antibodies. Cardiac failure and hydrops may occur
with severe disease.
Hypothyroid
Hypothyroid
Effect Maternal Large case-control study demonstrated a seven-point reduction in IQ among
Effect
Thyroid
Maternal
children born to untreated overtly hypothyroid women compared to euthyroid
Thyroid
controls, Findings also supported a delay in motor skill development, language
Management
development, and attention at 7–9 years of age.
Benefit
Management
Preventive
Benefit Congenital hypothyroidism are due to agenesis or dysgenesis of the fetal thyroid,
congenital dyshormonogenesis, or iodine deficiency in endemic areas. This topic
Conclusion
conclucion is reviewed in detail separately
Introduction
Introduction
Effect Maternal Thyroid to Neonatal
Physiology in
Physiology in
Pregnancy
Pregnancy

Causes
Causes Hyperthyroid Hypothyroid
Hyperthyroid
Hyperthyroid Congenital malformations Of Heart, Kidney or Neurodevelopmental delay
Hypothyroid
Hypothyroid Brain Stunted growth / Congenital cretinism

Effect Maternal Fetal Grave diseases Mental Retardation

Effect
Thyroid
Maternal Fetal tachycardia Peripartum hypoxia
Thyroid
Management High output Heart failure Increased risk neonatal mortality

Benefit
Management Craniosynostosis
Low Birth Weight
Preventive
Benefit
Fetal Goiter
Conclusion
conclucion Fetal demise
 Screening For Risk Population
Introduction

Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect Maternal
Thyroid

Management

Benefit

Preventive

Conclusion

Thyroid dysfunction and reproductive health, Amanda Jeffery, 2015

Introduction
Effect Medicine For Thyroid Hormone
Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect
Maternal
Thyroid

Management

Benefit

Preventive

Conclusion
 Introduction

Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect Maternal
Thyroid

Management

Benefit

Preventive

Conclusion
Clinical Algorithm for Management of Thyroid
Disease in Pregnancy : ACOG 2020
 Management Hyperthyroid in Pregnancy
Introduction

Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect Maternal
Thyroid

Management

Benefit

Preventive

Conclusion

Diagnosis and Management of Hyperthyroidism in Pregnancy: A Review, Jennifer Renae King, 2016
 Management Hyperthyroid in Pregnancy
Introduction

Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effec Maternal
Thyroid

Management

Benefit

Preventive

Conclusion

Diagnosis and Management of Hyperthyroidism in Pregnancy: A Review, Jennifer Renae King, 2016
 Management Hyperthyroid in Pregnancy
Introduction

Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effec Maternal
Thyroid

Management

Benefit

Preventive

Conclusion

Diagnosis and Management of Hyperthyroidism in Pregnancy: A Review, Jennifer Renae King, 2016
 Management Hypothyroid in Pregnancy
Introduction

Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect Maternal
Thyroid

Management

Benefit

Preventive

Conclusion

Hypothyroidism in pregnancy, : A Review, Weiping Teng, 2013

 Management Hypothyroid in Pregnancy
Introduction

Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect Maternal
Thyroid

Management

Benefit

Preventive

Conclusion

Hypothyroidism in pregnancy, : A Review, Weiping Teng, 2013

 Levothyroxine Therapy In Gestational
Introduction
Subclinical Hypothyroidism
Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect
Maternal
Thyroid

Management

Benefit

Preventive

Conclusion

Preconception management of thyroid dysfunction, Onyebuchi E. Okosieme, 2018

 Screening for Newborn at Risk Thyrotoxicosis
Introduction

Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect Maternal
Thyroid

Management

Screening
neonatal

Benefit

Preventive

Conclusion
 Introduction
Management for Newborn with Thyrotoxicosis
Physiology in
Pregnancy

Causes

Hyperthyroid

Hypothyroid

Effect Maternal
Thyroid

Management

Screening
neonatal

Management
Neonatal

Benefit

Preventive

Conclusion
Introduction
Benefit Treatment Maternal thyroid Dysfunctional
Physiology in
Pregnancy

Causes
• Prevent maternal, fetal and neonatal death
Hyperthyroid
• Prevent maternal, fetal and neonatal morbidity
Hypothyroid
• Reduce maternal disability and disability of offspring
Effect
Maternal
• Increase the IQ of the whole population
Thyroid

Management

Benefit

Preventive

Conclusion
Introduction
The benefits of a high IQ
Physiology in
Pregnancy
• Better educational achievement
Causes
• Well-paid employment
Hyperthyroid
• Enhanced social status
Hypothyroid
• Less criminal behaviour
Effect
Maternal • Longer life
Thyroid

Management

Benefit

Preventive

Conclusion
Introduction
RECOMENDATION
Physiology in
Pregnancy

Causes Preconception Counceling

Hyperthyroid
ACOG recommendation → Screening of All pregnant women with a
Hypothyroid personal history, physical examination, or symtomps of thyroid disorder

Effect
Maternal
Thyroid
The World Health Organization (WHO) recommends 250 mcg of
Management iodine daily during pregnancy and lactation.

Benefit
Good Postnatal Care
Preventive

Conclusion
Introduction
Conclusion
Physiology in
Pregnancy

Causes • Maternal iodine status and thyroid disease during pregnancy were
associated with adverse pregnancy outcomes.
Hyperthyroid

Hypothyroid • We should pay more attention to iodine nutritional surveillance and

thyroid disease screening in pregnant women.
Effect
Maternal
• All pregnant women or women desiring pregnancy should be screened for
Thyroid thyroid dysfunction either prior to pregnancy, or at the first prenatal visit.
Management
• Universal screening for thyroid dysfunction should consist of a TSH level
Benefit with a reflex fT4 if the TSH is elevated and a reflex TT3 if the TSH is
suppressed
Preventive

Conclusion
Thank you