Prevalence of Gestational Auto-immune Thyroid Dysfunction and its Association with Anaemia In A Rural District Of West Bengal
DOI:
https://doi.org/10.37506/1ym2ez47Keywords:
Thyroid disorders, anti TPO antibody, Iron deficiency anaemia, GestationAbstract
Background: Maternal thyroid dysfunction is associated with risk of obstetric complications and also heralding the risk of abnormal fetal neuro-development. The prevalence and type of thyroid dysfunction in pregnancy varies widely according to ethnicity, demographic and geographical location. Thyroid dysfunction in pregnancy may be associated with autoimmune component too. Anaemia in pregnancy may aggravate with thyroid dysfunction in comparison to euthyroid pregnant subjects. Some epidemiological studies suggested that Iron deficiency anemia may be related to autoimmune thyroid dysfunction in pregnancy. This study aimed to estimate the prevalence of thyroid dysfunction in different trimesters of pregnancy, the association with anemia in pregnancy and whether autoimmunity plays a role in development of thyroid disorder.
Methodology: A cross-sectional study was conducted over a period of 1 year in the department of Biochemistry of Bankura Sammilani Medical College. Antenatal mothers attending the antenatal OPD in different trimester were selected depending on predefined inclusion and exclusion criteria. Blood samples were collected for estimation of serum TSH, Free T4, haemoglobin, haematocrit, RBC indices. Serum anti-TPO antibody was estimated only in patients with altered thyroid hormone concentration. Results of the study was compiled, tabulated and analysed using SPSS version 21.
Results: 326 pregnant mothers were included as study participants among which 164 were in first trimester and 162 were in second trimester.The prevalence of hypothyroidism among pregnant women was found to be 46.3 % whereas only 1.8% were hyperthyroid.93.3% of the hypothyroid pregnant women had sub-clinical hypothyroidism and the remaining had overt hypothyroidism. 8 subjects out of the total 157 patients with deranged thyroid function were found to be anti-TPO positive. The prevalence of iron deficiency anaemia among hypothyroid mothers were 36.4% in comparison to 33.1 % in non-hypothyroid mothers.
Conclusion: Screening of thyroid function status in various stages of gestation is essential because of the high prevalence of hypothyroidism among pregnant women. Estimation of serum anti TPO antibody should be done in all thyroid dysfunctions. Thyroid disorders in pregnancy may be associated with increased severity of iron deficiency anaemia.
References
Van Raaij JM, Vermaat-Miedema SH, Schonk CM, Peek ME, Hautvast JG. Energy requirements of pregnancy in The Netherlands. Lancet. 1987; 2: 953-5.
Nambiar V, Jagtap VS, Sarathi V, Lila AR, Kamalanathan S, Bandgar TR, et al. Prevalence and impact of thyroid disorders on maternal outcome in Asian Indian pregnant women. J Thyroid Res. 2011; 2011: 4290-7.
Sahu MT, Das V, Mittal S, Agarwal A, Sahu M. Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome. Arch Gynecol Obstet. 2010; 281: 215-20
Szczepanek-Parulska E, Hernik A, Ruchała M. Anaemia in thyroid diseases. Pol Arch Intern Med. 2017 May 31;127(5):352-360. doi: 10.20452/pamw.3985. Epub 2017 Mar 28. PMID: 28400547.
Gianoukakis AG, Leigh MJ, Richards P, et al. Characterization of theanaemia associated with Graves’ disease. ClinEndocrinol (Oxf). 2009; 70:781-787.
Khatiwada S, Gelal B, Baral N, Lamsal M. Association between ironstatus and thyroid function in Nepalese children. Thyroid Res. 2016; 9: 2.
Cuschieri S. The STROBE guidelines. Saudi J Anaesth. 2019 Apr;13(Suppl 1):S31-S34. doi: 10.4103/sja.SJA_543_18. PMID: 30930717; PMCID: PMC6398292.
TriptiSaxena, Pawan Kumar kare, HaresinghMakwane, ChiragGarg et al. Thyroid Dysfunction among Pregnant Women during Different Trimesters of Pregnancy: A Tertiary Care HospitalBased Observational Study. National Journal of Laboratory Medicine. 2020 Jul, Vol-9(3): BO01-BO05
Lazarus J, Brown RS, Daumerie C, et al. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. EurThyroid J 2014;3(2):76–94
Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011; 21(10): 1081-125.
American College of Obstetricians and Gynecologists. ACOG practice bulletin no.95: anemia in pregnancy. Obstet Gynecol. 2008;112(1):201–207.
Dhanwal D, Bajaj S, Rajput R, Subramaniam KAV, Chowdhury S, Bhandari R, et al. Prevalence of hypothyroidism in pregnancy: An epidemiological study from 11 cities in 9 states of India. Indian Journal of Endocrinology and Metabolism. 2016;20(3):387.
Nidhi J, Melse-Boonstra A, Thomas T, Basavaraj C, Sharma SK, Srinivasan K, et al. High prevalence of maternal hypothyroidism despite adequate iodine status in Indian pregnant women in the first trimester. Thyroid. 2014;24(9):1419-29.
Agrawal U, Shrivastava P, Shrivastava S. Hypothyroidism and anaemia in pregnancy. Int J Adv Med. 2016;3(4):851-54.
De Groot L, Abalovich M, Alexander EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(8):2543-2565
Gietka-Czemel M, Glinicki P. Subclinical hypothyroidism in pregnancy: controversies on diagnosis and treatment. Pol Arch Intern Med. 2021;131:266-275.
Papanastasiou L, Vatalas IA, Koutras DA, et al. Thyroid autoimmunity in the current iodine environment. Thyroid 2007;17:729-39
Shi X, Han C, Li C, et al. Optimal and safe upper limits of iodine intake for early pregnancy in iodine-sufficient regions: a cross-sectional study of 7190 pregnant women in China. J Clin Endocrinol Metab 2015;100:1630-8
Khadija M’RB, Aubert CE, Coslovsky M, Collet TH, Baumgartner C, den Elzen WPJ, et al. Thyroid dysfunction and anaemia in a large population-based study. Clin Endocrinol (Oxf). 2016;84(4):627-31.
Singh N, Mani P, Yadav L,Naresh N. Study of anemia in hypothyroid pregnant patients. Int J Reprod Contracept Obstet Gynecol2020;9:1686-90.
De Leo S, Pearce EN. Autoimmune thyroid disease during pregnancy. Lancet Diabetes Endocrinol. 2018 Jul;6(7):575-586.
Yang Y, Hou Y, Wang H, Gao X, Wang X, Li J, Teng W, Shan Z. Maternal Thyroid Dysfunction and Gestational Anemia Risk: Meta-Analysis and New Data. Front Endocrinol (Lausanne). 2020 Apr 15;11:201.
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