Research Progress on the Relationship between Subclinical Hypothyroidism in Pregnancy and Hypertensive Disorders of Pregnancy

doi:10.12280/gjfckx.20230471

Abstract

Abstract:

Subclinical hypothyroidism (SCH) is the most common thyroid diseases during pregnancy. The vascular endothelial function injury and autonomic nervous dysfunction in SCH patients may increase the risk of cardiovascular diseases. Hypertensive disorders of pregnancy (HDP) complicate pregnancy and lead to increased rates of adverse pregnancy outcomes and mortality for both mothers and fetuses. Studies have found that SCH is associated with the increased incidence of HDP, but there is no uniform conclusion at present, and the potential benefits of levothyroxine (L-T₄) treatment for HDP in SCH pregnant women are still controversial. This article reviews the impact of SCH on HDP during pregnancy and the effectiveness of L-T₄ treatment, so as to standardize the clinical pregnancy management program and reduce the occurrence of perinatal adverse pregnancy outcomes in pregnant women and fetus.

Key words: Hypothyroidism, Hypertension, pregnancy-induced, Thyrotropin, Pregnant women, Levothyroxine

HU Min-hui, LIU Rui-xia, ZHAO Rong, YIN Cheng-hong. Research Progress on the Relationship between Subclinical Hypothyroidism in Pregnancy and Hypertensive Disorders of Pregnancy[J]. Journal of International Obstetrics and Gynecology, 2023, 50(6): 679-683.

References 33

[1]	Dong AC, Stagnaro-Green A. Differences in Diagnostic Criteria Mask the True Prevalence of Thyroid Disease in Pregnancy: A Systematic Review and Meta-Analysis[J]. Thyroid, 2019, 29(2):278-289. doi: 10.1089/thy.2018.0475. pmid: 30444186
[2]	Shan Z, Chen L, Lian X, et al. Iodine Status and Prevalence of Thyroid Disorders After Introduction of Mandatory Universal Salt Iodization for 16 Years in China: A Cross-Sectional Study in 10 Cities[J]. Thyroid, 2016, 26(8):1125-1130. doi: 10.1089/thy.2015.0613. pmid: 27370068
[3]	胡静, 王海宁, 曾琳, 等. 孕早期双胎妊娠甲状腺功能减退对妊娠结局的影响[J]. 中国妇产科临床杂志, 2022, 23(3):228-231. doi: 10.13390/j.issn.1672-1861.2022.03.002.
[4]	Chen Y, Lin M, Guo P, et al. Uterine fibroids increase the risk of hypertensive disorders of pregnancy: a prospective cohort study[J]. J Hypertens, 2021, 39(5):1002-1008. doi: 10.1097/HJH.0000000000002729. pmid: 33315757
[5]	Chen LM, Du WJ, Dai J, et al. Effects of subclinical hypothyroidism on maternal and perinatal outcomes during pregnancy: a single-center cohort study of a Chinese population[J]. PLoS One, 2014, 9(10):e109364. doi: 10.1371/journal.pone.0109364.
[6]	Wu MQ, Liu J, Wang YQ, et al. The Impact of Subclinical Hypothyroidism on Adverse Perinatal Outcomes and the Role of Thyroid Screening in Pregnancy[J]. Front Endocrinol(Lausanne), 2019, 10:522. doi: 10.3389/fendo.2019.00522.
[7]	Zhu P, Chu R, Pan S, et al. Impact of TPOAb-negative maternal subclinical hypothyroidism in early pregnancy on adverse pregnancy outcomes[J]. Ther Adv Endocrinol Metab, 2021, 12:20420188211054690. doi: 10.1177/20420188211054690.
[8]	Toloza F, Derakhshan A, Männistö T, et al. Association between maternal thyroid function and risk of gestational hypertension and pre-eclampsia: a systematic review and individual-participant data meta-analysis[J]. Lancet Diabetes Endocrinol, 2022, 10(4):243-252. doi: 10.1016/S2213-8587(22)00007-9.
[9]	Dash SC, Sahoo N, Rout U, et al. Outcomes With Levothyroxine Treatment in Early Pregnancy With Subclinical Hypothyroidism[J]. Cureus, 2022, 14(5):e24984. doi: 10.7759/cureus.24984.
[10]	Jiang F, Wang H, Bao S, et al. Thyrotropin Regulates eNOS Expression in the Endothelium by PGRN Through Akt Pathway[J]. Front Endocrinol(Lausanne), 2018, 9:353. doi: 10.3389/fendo.2018.00353.
[11]	Karthiga K, Pal GK, Dasari P, et al. Attenuation of baroreflex sensitivity and heart rate variability is linked to reduced levels of nitric oxide in pregnant women having risks of developing gestational hypertension[J]. Clin Exp Hypertens, 2021, 43(4):356-362. doi: 10.1080/10641963.2021.1883053.
[12]	Yao X, Wang Y, Wang L, et al. Expression patterns of serum MicroRNAs related to endothelial dysfunction in patients with subclinical hypothyroidism[J]. Front Endocrinol(Lausanne), 2022, 13:981622. doi: 10.3389/fendo.2022.981622.
[13]	Wang L, Liu J, Lu K, et al. Long non-coding RNA NEAT1 regulates endothelial functions in subclinical hypothyroidism through miR-126/TRAF7 pathway[J]. Hum Cell, 2021, 34(3):825-835. doi: 10.1007/s13577-021-00508-0. pmid: 33677813
[14]	Mavai M, Bhandari B, Singhal A, et al. Cardiac Autonomic Modulation and Anti-Thyroid Peroxidase (TPO) Antibodies in Subclinical Hypothyroidism: Does a Correlation Exist?[J]. Cureus, 2021, 13(10):e18844. doi: 10.7759/cureus.18844.
[15]	Brusseau V, Tauveron I, Bagheri R, et al. Heart rate variability in hypothyroid patients: A systematic review and meta-analysis[J]. PLoS One, 2022, 17(6):e0269277. doi: 10.1371/journal.pone.0269277.
[16]	Syamsunder AN, Pal P, Pal GK, et al. Decreased baroreflex sensitivity is linked to the atherogenic index, retrograde inflammation, and oxidative stress in subclinical hypothyroidism[J]. Endocr Res, 2017, 42(1):49-58. doi: 10.1080/07435800.2016.1181648. pmid: 27260547
[17]	Magee LA, Brown MA, Hall DR, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice[J]. Pregnancy Hypertens,2022, 27:148-169. doi: 10.1016/j.preghy.2021.09.008.
[18]	Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222[J]. Obstet Gynecol, 2020, 135(6):e237-e260. doi: 10.1097/AOG.0000000000003891.
[19]	Han Y, Wang J, Wang X, et al. Relationship Between Subclinical Hypothyroidism in Pregnancy and Hypertensive Disorder of Pregnancy: A Systematic Review and Meta-Analysis[J]. Front Endocrinol(Lausanne), 2022, 13:823710. doi: 10.3389/fendo.2022.823710.
[20]	Korevaar TI, Steegers EA, Pop VJ, et al. Thyroid Autoimmunity Impairs the Thyroidal Response to Human Chorionic Gonadotropin: Two Population-Based Prospective Cohort Studies[J]. J Clin Endocrinol Metab, 2017, 102(1):69-77. doi: 10.1210/jc.2016-2942. pmid: 27754809
[21]	Magri F, Bellingeri C, De Maggio I, et al. A first-trimester serum TSH in the 4-10 mIU/L range is associated with obstetric complications in thyroid peroxidase antibody-negative women[J]. J Endocrinol Invest, 2023, 46(7):1407-1414. doi: 10.1007/s40618-022-01996-z.
[22]	Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum[J]. Thyroid,2017, 27(3):315-389. doi: 10.1089/thy.2016.0457.
[23]	Stagnaro-Green A, Abalovich M, Alexander E, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum[J]. Thyroid, 2011, 21(10):1081-1125. doi: 10.1089/thy.2011.0087. pmid: 21787128
[24]	Li MF, Ma L, Feng QM, et al. Effects of Maternal Subclinical Hypothyroidism in Early Pregnancy Diagnosed by Different Criteria on Adverse Perinatal Outcomes in Chinese Women With Negative TPOAb[J]. Front Endocrinol(Lausanne), 2020, 11:580380. doi: 10.3389/fendo.2020.580380.
[25]	Lee SY, Cabral HJ, Aschengrau A, et al. Associations Between Maternal Thyroid Function in Pregnancy and Obstetric and Perinatal Outcomes[J]. J Clin Endocrinol Metab, 2020, 105(5):e2015-e2023. doi: 10.1210/clinem/dgz275.
[26]	Abdi H, Faam B, Gharibzadeh S, et al. Determination of age and sex specific TSH and FT4 reference limits in overweight and obese individuals in an iodine-replete region: Tehran Thyroid Study (TTS)[J]. Endocr Res, 2021, 46(1):37-43. doi: 10.1080/07435800.2020.1854778. pmid: 33280458
[27]	Zhao L, Teng D, Shi X, et al. The Effect of Increased Iodine Intake on Serum Thyrotropin: A Cross-Sectional, Chinese Nationwide Study[J]. Thyroid, 2020, 30(12):1810-1819. doi: 10.1089/thy.2019.0842.
[28]	Poppe K, Bisschop P, Fugazzola L, et al. 2021 European Thyroid Association Guideline on Thyroid Disorders prior to and during Assisted Reproduction[J]. Eur Thyroid J,2021, 9(6):281-295. doi: 10.1159/000512790.
[29]	Zhang Y, Sun W, Zhu S, et al. The Impact of Thyroid Function and TPOAb in the First Trimester on Pregnancy Outcomes: A Retrospective Study in Peking[J]. J Clin Endocrinol Metab, 2020, 105(3):dgz167. doi: 10.1210/clinem/dgz167.
[30]	Lemieux P, Yamamoto JM, Nerenberg KA, et al. Thyroid Laboratory Testing and Management in Women on Thyroid Replacement Before Pregnancy and Associated Pregnancy Outcomes[J]. Thyroid, 2021, 31(5):841-849. doi: 10.1089/thy.2020.0609. pmid: 33108964
[31]	Yuan N, Sun J, Zhao X, et al. Untreated thyroid autoantibody-negative SCH increases the risk of spontaneous abortions[J]. Endocr Connect, 2022, 11(4):e210600. doi: 10.1530/EC-21-0600.
[32]	Jiao XF, Zhang M, Chen J, et al. The impact of levothyroxine therapy on the pregnancy, neonatal and childhood outcomes of subclinical hypothyroidism during pregnancy: An updated systematic review, meta-analysis and trial sequential analysis[J]. Front Endocrinol(Lausanne), 2022, 13:964084. doi: 10.3389/fendo.2022.964084.
[33]	董丽涛. 左甲状腺素钠片治疗妊娠期亚临床甲状腺功能减退症的效果及对妊娠结局的影响[J]. 中国实用医刊, 2022, 49(22):90-93. doi: 10.3760/cma.j.cn115689-20220827-03983.