Association between previously unknown connective tissue disease and subclinical hypothyroidism diagnosed during first trimester of pregnancy

Fausta Beneventi, Elena Locatelli, Claudia Alpini, Elisabetta Lovati, Véronique Ramoni, Margherita Simonetta, Chiara Cavagnoli, Arsenio Spinillo

Research output: Contribution to journalArticle

Abstract

Objective To investigate the presence of autoimmune rheumatic disorders among women with autoimmune thyroid disorders diagnosed during the first trimester of pregnancy and subsequent pregnancy outcomes. Design Case-control study. Setting Tertiary obstetric and gynecologic center. Patient(s) Pregnant women in the first trimester of pregnancy. Intervention(s) Clinical, laboratory, ultrasonographic evaluations. Main Outcome Measure(s) Thyroid-stimulating hormone (TSH) level; antibodies against thyroperoxidase, thyroid globulin and TSH receptor detection; screening for rheumatic symptoms and antinuclear antibodies (ANA); uterine artery pulsatility index evaluation; pregnancy complication onset. Result(s) Out of 3,450 women enrolled, 106 (3%) were diagnosed with autoimmune thyroid disorders. ANA were present in 18 (16.9%) of 106 cases and 26 (12.6%) of 206 controls. Of the cases, 28 (26.4%) of 106 reported rheumatic symptoms, 5 of these were diagnosed with Sjögren syndrome or with undefined connective tissue disease. Autoimmune thyroid diseases are statistically significantly associated with a higher risk of preeclampsia, fetal growth restriction, and overall pregnancy complications compared with controls, with a higher uterine artery pulsatility index, suggesting a defective placentation in thyroid disorders. The effect of ANA-positivity on moderate/severe adverse pregnancy outcomes was statistically significant among the patients with thyroid disorders (9 of 18 as compared to 8 of 88, odds ratio 9.65; 95% confidence interval, 2.613-7.81). Conclusion(s) Connective tissue diseases are frequently associated with autoimmune thyroid disorders diagnosed during the first trimester of pregnancy. Thyroid autoimmunity and ANA positivity independently increased the risk of adverse pregnancy outcomes.

Original languageEnglish
Pages (from-to)1195-1201
Number of pages7
JournalFertility and Sterility
Volume104
Issue number5
DOIs
Publication statusPublished - Nov 1 2015

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Connective Tissue Diseases
First Pregnancy Trimester
Hypothyroidism
Thyroid Gland
Antinuclear Antibodies
Pregnancy Outcome
Uterine Artery
Pregnancy Complications
Thyrotropin Receptors
Placentation
Thyroid Diseases
Globulins
Thyrotropin
Fetal Development
Pre-Eclampsia
Autoimmunity
Autoimmune Diseases
Obstetrics
Case-Control Studies
Pregnant Women

Keywords

  • Antinuclear antibodies
  • pregnancy
  • subclinical hypothyroidism

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Reproductive Medicine
  • Medicine(all)

Cite this

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title = "Association between previously unknown connective tissue disease and subclinical hypothyroidism diagnosed during first trimester of pregnancy",
abstract = "Objective To investigate the presence of autoimmune rheumatic disorders among women with autoimmune thyroid disorders diagnosed during the first trimester of pregnancy and subsequent pregnancy outcomes. Design Case-control study. Setting Tertiary obstetric and gynecologic center. Patient(s) Pregnant women in the first trimester of pregnancy. Intervention(s) Clinical, laboratory, ultrasonographic evaluations. Main Outcome Measure(s) Thyroid-stimulating hormone (TSH) level; antibodies against thyroperoxidase, thyroid globulin and TSH receptor detection; screening for rheumatic symptoms and antinuclear antibodies (ANA); uterine artery pulsatility index evaluation; pregnancy complication onset. Result(s) Out of 3,450 women enrolled, 106 (3{\%}) were diagnosed with autoimmune thyroid disorders. ANA were present in 18 (16.9{\%}) of 106 cases and 26 (12.6{\%}) of 206 controls. Of the cases, 28 (26.4{\%}) of 106 reported rheumatic symptoms, 5 of these were diagnosed with Sj{\"o}gren syndrome or with undefined connective tissue disease. Autoimmune thyroid diseases are statistically significantly associated with a higher risk of preeclampsia, fetal growth restriction, and overall pregnancy complications compared with controls, with a higher uterine artery pulsatility index, suggesting a defective placentation in thyroid disorders. The effect of ANA-positivity on moderate/severe adverse pregnancy outcomes was statistically significant among the patients with thyroid disorders (9 of 18 as compared to 8 of 88, odds ratio 9.65; 95{\%} confidence interval, 2.613-7.81). Conclusion(s) Connective tissue diseases are frequently associated with autoimmune thyroid disorders diagnosed during the first trimester of pregnancy. Thyroid autoimmunity and ANA positivity independently increased the risk of adverse pregnancy outcomes.",
keywords = "Antinuclear antibodies, pregnancy, subclinical hypothyroidism",
author = "Fausta Beneventi and Elena Locatelli and Claudia Alpini and Elisabetta Lovati and V{\'e}ronique Ramoni and Margherita Simonetta and Chiara Cavagnoli and Arsenio Spinillo",
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T1 - Association between previously unknown connective tissue disease and subclinical hypothyroidism diagnosed during first trimester of pregnancy

AU - Beneventi, Fausta

AU - Locatelli, Elena

AU - Alpini, Claudia

AU - Lovati, Elisabetta

AU - Ramoni, Véronique

AU - Simonetta, Margherita

AU - Cavagnoli, Chiara

AU - Spinillo, Arsenio

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Objective To investigate the presence of autoimmune rheumatic disorders among women with autoimmune thyroid disorders diagnosed during the first trimester of pregnancy and subsequent pregnancy outcomes. Design Case-control study. Setting Tertiary obstetric and gynecologic center. Patient(s) Pregnant women in the first trimester of pregnancy. Intervention(s) Clinical, laboratory, ultrasonographic evaluations. Main Outcome Measure(s) Thyroid-stimulating hormone (TSH) level; antibodies against thyroperoxidase, thyroid globulin and TSH receptor detection; screening for rheumatic symptoms and antinuclear antibodies (ANA); uterine artery pulsatility index evaluation; pregnancy complication onset. Result(s) Out of 3,450 women enrolled, 106 (3%) were diagnosed with autoimmune thyroid disorders. ANA were present in 18 (16.9%) of 106 cases and 26 (12.6%) of 206 controls. Of the cases, 28 (26.4%) of 106 reported rheumatic symptoms, 5 of these were diagnosed with Sjögren syndrome or with undefined connective tissue disease. Autoimmune thyroid diseases are statistically significantly associated with a higher risk of preeclampsia, fetal growth restriction, and overall pregnancy complications compared with controls, with a higher uterine artery pulsatility index, suggesting a defective placentation in thyroid disorders. The effect of ANA-positivity on moderate/severe adverse pregnancy outcomes was statistically significant among the patients with thyroid disorders (9 of 18 as compared to 8 of 88, odds ratio 9.65; 95% confidence interval, 2.613-7.81). Conclusion(s) Connective tissue diseases are frequently associated with autoimmune thyroid disorders diagnosed during the first trimester of pregnancy. Thyroid autoimmunity and ANA positivity independently increased the risk of adverse pregnancy outcomes.

AB - Objective To investigate the presence of autoimmune rheumatic disorders among women with autoimmune thyroid disorders diagnosed during the first trimester of pregnancy and subsequent pregnancy outcomes. Design Case-control study. Setting Tertiary obstetric and gynecologic center. Patient(s) Pregnant women in the first trimester of pregnancy. Intervention(s) Clinical, laboratory, ultrasonographic evaluations. Main Outcome Measure(s) Thyroid-stimulating hormone (TSH) level; antibodies against thyroperoxidase, thyroid globulin and TSH receptor detection; screening for rheumatic symptoms and antinuclear antibodies (ANA); uterine artery pulsatility index evaluation; pregnancy complication onset. Result(s) Out of 3,450 women enrolled, 106 (3%) were diagnosed with autoimmune thyroid disorders. ANA were present in 18 (16.9%) of 106 cases and 26 (12.6%) of 206 controls. Of the cases, 28 (26.4%) of 106 reported rheumatic symptoms, 5 of these were diagnosed with Sjögren syndrome or with undefined connective tissue disease. Autoimmune thyroid diseases are statistically significantly associated with a higher risk of preeclampsia, fetal growth restriction, and overall pregnancy complications compared with controls, with a higher uterine artery pulsatility index, suggesting a defective placentation in thyroid disorders. The effect of ANA-positivity on moderate/severe adverse pregnancy outcomes was statistically significant among the patients with thyroid disorders (9 of 18 as compared to 8 of 88, odds ratio 9.65; 95% confidence interval, 2.613-7.81). Conclusion(s) Connective tissue diseases are frequently associated with autoimmune thyroid disorders diagnosed during the first trimester of pregnancy. Thyroid autoimmunity and ANA positivity independently increased the risk of adverse pregnancy outcomes.

KW - Antinuclear antibodies

KW - pregnancy

KW - subclinical hypothyroidism

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