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GEBELERDE İLK TRİMESTER TSH SEVİYELERİNİN FETAL DOĞUM AĞIRLIKLARINA VE MATERNAL HEMOGLOBİN DEĞERLERİ ÜZERİNE ETKİSİ

Year 2021, Volume: 18 Issue: 1, 742 - 745, 01.04.2021
https://doi.org/10.38136/jgon.800398

Abstract

ÖZET
Amaç: Gebelerde ilk trimester TSH seviyelerinin fetal doğum ağırlıklarına ve maternal hemoglobin değerleri üzerine etkisini araştırmak
Gereç ve Yöntemler: Çalışmamız Mart 2018-Nisan 2019 tarihleri arasında İkinci Basamak Devlet Hastanesi Kadın Hastalıkları ve Doğum bölümüne gebeliğinin ilk trimesterinde başvuran 293 tekil gebenin dahil edildiği retrospektif bir çalışmadır. Gebelik öncesi tiroid hastalıkları nedeniyle tedavi alanlar, diabetes mellitusu olanlar, preeklampsi gelişenler, kalp hastalığı olanlar, sigara ve alkol kullananlar, 37 haftadan önce doğum yapanlar çalışma dışı bırakılmıştır. Hastalar TSH seviyelerine göre üç gruba ayrıldı. Birinci grup TSH seviyesi <0,1 mU/L, ikinci grup TSH seviyesi 0,1-2,5 mU/L, üçüncü grupta TSH seviyesi >2,5 mU/L olarak alındı. Gruplar doğum kilosu, doğum şekli, maternal hemoglobin değeri açısından karşılaştırılmıştır. Hastalar bebek doğum ağırlıklarına göre 3 gruba ayrıldı. Bunlar 2500 gram altı, 2500-4000 gram arası, 4000 gram üzerine göre sınıflandırıldı ve TSH düzeylerine göre bebek doğum ağırlıkları karşılaştırıldı.
Bulgular: Gruplar arasında doğum şekli açısından istatistiksel olarak anlamlı fark izlenmedi (p>0.05). TSH düzeyi 2,5’den düşük olan hastalarda maternal ilk trimester hemoglobin düzeyleri TSH düzeyi 2,5’den büyük olan hastalara göre istatistiksel olarak anlamlı düzeyde daha yüksek olarak saptandı (p=0,001). Her üç TSH grubunda da doğum ağırlıkları açısından sonuçlar benzerdi ve istatistiksel olarak anlamlı bir fark izlenmedi (p>0,05).
Sonuç: Tiroid fonksiyon bozukluklarının gebeliğin seyrine olumsuz etkisi bilinmektedir. İlk trimester TSH düzeyiyle, fetal doğum ağırlığı ve maternal hemoglobin düzeyi arasındaki ilişkiyi tanımlamak için daha geniş çalışmalara ihtiyaç vardır.

References

  • 1. Negro, R. and J.H. Mestman, Thyroid disease in pregnancy. Best Practice & Research Clinical Endocrinology & Metabolism 2011. 25(6); 927-943.
  • 2. Negro, R., Significance and management of low TSH in pregnancy. The Thyroid and Reproduction. Georg Thieme Verlag, New York 2009; 84-95.
  • 3. Alexander, E.K., E.N. Pearce, G.A. Brent, R.S. Brown, H. Chen, C. Dosiou, et al., 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 2017. 27(3); 315-389.
  • 4. Stagnaro-Green, A., M. Abalovich, E. Alexander, F. Azizi, J. Mestman, R. Negro, et al., Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011. 21(10); 1081-1125.
  • 5. tt, Tiroid Hastalıkları Tanı ve Tedavi Kılavuzu 2019. Türkiye Endokrinoloji ve Metabolizma Derneği. Türkiye Klinikleri Yayın Seri No: 347. 4. Baskı, Nisan 2019. ISBN: 978-605-4011-37-7.
  • 6. De Groot, L., M. Abalovich, E.K. Alexander, N. Amino, L. Barbour, R.H. Cobin, et al., Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism 2012. 97(8); 2543-2565.
  • 7. Abalovich, M., G. Alcaraz, J. Kleiman-Rubinsztein, M.M. Pavlove, C. Cornelio, O. Levalle, et al., The relationship of preconception thyrotropin levels to requirements for increasing the levothyroxine dose during pregnancy in women with primary hypothyroidism. Thyroid 2010. 20(10); 1175-1178.
  • 8. Kabaca, S., H. Bozdağ, F.B.S. Öğütçüoğlu, F. Gökdağlı, H. Kavak, and N.C. Tanyolaç, İlk Trimester Gebeliklerde Subklinik Tiroid Fonksiyon Bozuklukları ve Obstetrik Sonuçlar Üzerine Etkisi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi 2016. 13(4).
  • 9. Aker, S.Ş., T. Yüce, M. Atasever, M. Seval, and F. Söylemez, İlk Trimester TSH Düzeyinin Obstetrik ve Perinatal Sonuçlara Etkisi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi 2016. 13(3).
  • 10. Medici, M., S. Timmermans, W. Visser, S.M. de Muinck Keizer-Schrama, V.W. Jaddoe, A. Hofman, et al., Maternal thyroid hormone parameters during early pregnancy and birth weight: the Generation R Study. The Journal of Clinical Endocrinology & Metabolism 2013. 98(1); 59-66.
  • 11. Achit, S., T. Dhar, K. Awasthi, B. Uppal, and J. Jacob, Obstetrical and neonatal outcomes in pregnant women with serum thyroid-stimulating hormone (TSH) levels> 2.0 mU/L vs. Those with TSH< 2.0 in the first trimester of pregnancy. Endocr Rev 2011. 32; 15-24.
  • 12. Mehmet, E., K. Aybike, S. Ganidagli, and K. Mustafa, Characteristics of anemia in subclinical and overt hypothyroid patients. Endocrine journal 2012. 59(3); 213-220.
  • 13. Obstetricians, A.C.o. and Gynecologists, Practice Bulletin No. 148: Thyroid disease in pregnancy. Obstetrics and gynecology 2015. 125(4); 996.
  • 14. Antonijević, N., M. Nesović, B. Trbojević, and R. Milosević, Anemia in hypothyroidism. Medicinski pregled 1999. 52(3-5); 136-140.
  • 15. Christ-Crain, M., C. Meier, P. Huber, H. Zulewski, J.-J. Staub, and B. Muller, Effect of restoration of euthyroidism on peripheral blood cells and erythropoietin in women with subclinical hypothyroidism. HORMONES-ATHENS- 2003. 2; 237-242.
  • 16. M'Rabet‐Bensalah, K., C.E. Aubert, M. Coslovsky, T.H. Collet, C. Baumgartner, W.P. den Elzen, et al., Thyroid dysfunction and anaemia in a large population‐based study. Clinical endocrinology 2016. 84(4); 627-631.
  • 17. Rosenfeld, H., A. Ornoy, S. Shechtman, and O. Diav‐Citrin, Pregnancy outcome, thyroid dysfunction and fetal goitre after in utero exposure to propylthiouracil: a controlled cohort study. British journal of clinical pharmacology 2009. 68(4); 609-617.
  • 18. Thorpe-Beeston, J., K.H. Nicolaides, R. Snijders, C.V. Felton, and A.M. McGREGOR, Thyroid function in small for gestational age fetuses. Obstetrics and gynecology 1991. 77(5); 701-706.

EFFECT OF FİRST TRİMESTER TSH LEVELS ON FETAL BİRTH WEİGHTS AND MATERNAL HEMOGLOBİN LEVELS İN PREGNANT WOMEN

Year 2021, Volume: 18 Issue: 1, 742 - 745, 01.04.2021
https://doi.org/10.38136/jgon.800398

Abstract

ABSTRACT
Aim: The aim of this study was to investigate the effect of first trimester TSH levels on fetal birth weight and maternal hemoglobin levels in pregnant women.
Material And Methods: The aim of this study was to investigate the effect of first trimester TSH levels on fetal birth weight and maternal hemoglobin levels in pregnant women.Patıents And Methods: Our study is a retrospective study of 293 singleton pregnant women admitted in the first trimester of pregnancy to the Department of Obstetrics and Gynecology at Second Stage State Hospital between March 2018 and April 2019. Those receiving treatment for thyroid diseases before pregnancy, those with diabetes mellitus, those who developed preeclampsia, patients with heart disease, smokers and alcohol users, and who delivered before 37 weeks were excluded from the study The patients were divided into three groups according to TSH levels. The first group had TSH level <0,1 mU/L, the second group had TSH level 0.1-2.5 mU/L, and the third group had TSH level >2.5 mU/L. Groups were compared in terms of birth weight, delivery type and maternal hemoglobin value. Patients were divided into 3 groups according to their birth weights. These were groups of birth weights under 2500 grams, between 2500-4000 grams and over 4000 grams and baby birth weights were compared according to maternal TSH levels.
Results: There was no statistically significant difference between groups in terms of delivery type (p>0.05). Maternal first trimester hemoglobin levels were found to be significantly higher in patients with TSH levels less than 2.5 mU/L (p=0.001). Results were similar in terms of birth weights in all three TSH groups and no statistically significant difference was observed (p>0,05).
Conclusion: Thyroid dysfunction is known to have a negative effect on the course of pregnancy. Further studies are needed to define the relationship between first trimester TSH level and fetal birth weight and maternal hemoglobin level.

References

  • 1. Negro, R. and J.H. Mestman, Thyroid disease in pregnancy. Best Practice & Research Clinical Endocrinology & Metabolism 2011. 25(6); 927-943.
  • 2. Negro, R., Significance and management of low TSH in pregnancy. The Thyroid and Reproduction. Georg Thieme Verlag, New York 2009; 84-95.
  • 3. Alexander, E.K., E.N. Pearce, G.A. Brent, R.S. Brown, H. Chen, C. Dosiou, et al., 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 2017. 27(3); 315-389.
  • 4. Stagnaro-Green, A., M. Abalovich, E. Alexander, F. Azizi, J. Mestman, R. Negro, et al., Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011. 21(10); 1081-1125.
  • 5. tt, Tiroid Hastalıkları Tanı ve Tedavi Kılavuzu 2019. Türkiye Endokrinoloji ve Metabolizma Derneği. Türkiye Klinikleri Yayın Seri No: 347. 4. Baskı, Nisan 2019. ISBN: 978-605-4011-37-7.
  • 6. De Groot, L., M. Abalovich, E.K. Alexander, N. Amino, L. Barbour, R.H. Cobin, et al., Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism 2012. 97(8); 2543-2565.
  • 7. Abalovich, M., G. Alcaraz, J. Kleiman-Rubinsztein, M.M. Pavlove, C. Cornelio, O. Levalle, et al., The relationship of preconception thyrotropin levels to requirements for increasing the levothyroxine dose during pregnancy in women with primary hypothyroidism. Thyroid 2010. 20(10); 1175-1178.
  • 8. Kabaca, S., H. Bozdağ, F.B.S. Öğütçüoğlu, F. Gökdağlı, H. Kavak, and N.C. Tanyolaç, İlk Trimester Gebeliklerde Subklinik Tiroid Fonksiyon Bozuklukları ve Obstetrik Sonuçlar Üzerine Etkisi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi 2016. 13(4).
  • 9. Aker, S.Ş., T. Yüce, M. Atasever, M. Seval, and F. Söylemez, İlk Trimester TSH Düzeyinin Obstetrik ve Perinatal Sonuçlara Etkisi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi 2016. 13(3).
  • 10. Medici, M., S. Timmermans, W. Visser, S.M. de Muinck Keizer-Schrama, V.W. Jaddoe, A. Hofman, et al., Maternal thyroid hormone parameters during early pregnancy and birth weight: the Generation R Study. The Journal of Clinical Endocrinology & Metabolism 2013. 98(1); 59-66.
  • 11. Achit, S., T. Dhar, K. Awasthi, B. Uppal, and J. Jacob, Obstetrical and neonatal outcomes in pregnant women with serum thyroid-stimulating hormone (TSH) levels> 2.0 mU/L vs. Those with TSH< 2.0 in the first trimester of pregnancy. Endocr Rev 2011. 32; 15-24.
  • 12. Mehmet, E., K. Aybike, S. Ganidagli, and K. Mustafa, Characteristics of anemia in subclinical and overt hypothyroid patients. Endocrine journal 2012. 59(3); 213-220.
  • 13. Obstetricians, A.C.o. and Gynecologists, Practice Bulletin No. 148: Thyroid disease in pregnancy. Obstetrics and gynecology 2015. 125(4); 996.
  • 14. Antonijević, N., M. Nesović, B. Trbojević, and R. Milosević, Anemia in hypothyroidism. Medicinski pregled 1999. 52(3-5); 136-140.
  • 15. Christ-Crain, M., C. Meier, P. Huber, H. Zulewski, J.-J. Staub, and B. Muller, Effect of restoration of euthyroidism on peripheral blood cells and erythropoietin in women with subclinical hypothyroidism. HORMONES-ATHENS- 2003. 2; 237-242.
  • 16. M'Rabet‐Bensalah, K., C.E. Aubert, M. Coslovsky, T.H. Collet, C. Baumgartner, W.P. den Elzen, et al., Thyroid dysfunction and anaemia in a large population‐based study. Clinical endocrinology 2016. 84(4); 627-631.
  • 17. Rosenfeld, H., A. Ornoy, S. Shechtman, and O. Diav‐Citrin, Pregnancy outcome, thyroid dysfunction and fetal goitre after in utero exposure to propylthiouracil: a controlled cohort study. British journal of clinical pharmacology 2009. 68(4); 609-617.
  • 18. Thorpe-Beeston, J., K.H. Nicolaides, R. Snijders, C.V. Felton, and A.M. McGREGOR, Thyroid function in small for gestational age fetuses. Obstetrics and gynecology 1991. 77(5); 701-706.
There are 18 citations in total.

Details

Primary Language Turkish
Subjects Obstetrics and Gynaecology
Journal Section Research Articles
Authors

Mustafa Bakırcı 0000-0002-4063-4409

Fatih Kılıç 0000-0002-7333-4883

Burak Ersak 0000-0003-3301-062X

Hakan Arslan 0000-0002-2673-6564

İlker Selcuk 0000-0003-0499-5722

Publication Date April 1, 2021
Submission Date September 26, 2020
Acceptance Date December 12, 2020
Published in Issue Year 2021 Volume: 18 Issue: 1

Cite

Vancouver Bakırcı M, Kılıç F, Ersak B, Arslan H, Selcuk İ. GEBELERDE İLK TRİMESTER TSH SEVİYELERİNİN FETAL DOĞUM AĞIRLIKLARINA VE MATERNAL HEMOGLOBİN DEĞERLERİ ÜZERİNE ETKİSİ. JGON. 2021;18(1):742-5.