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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (1): 111-116    DOI: 10.31083/j.ceog.2020.01.4975
Original Research Previous articles | Next articles
Relationship between subclinical hypothyroidism during pregnancy and hypertensive disorder complicating pregnancy and its poor prognosis
W.X. Chen1, L.Y. Tang1, *()
1Department of obstetrics, Shanghai Changning Maternal & Infant Health Hospital, Shanghai, China
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Abstract  

Objectives: Pregnancy-induced hypertension syndrome (PIH) is a common disease of pregnant women. This study explored the correlation between subclinical hypothyroidism (SCH) and PIH and the prognosis of patients with PIH. Materials and Methods: The study included 180 pregnant women were divided into three groups, including PIH+SCH group, PIH+non-SCH group, and normal group. Immunofluorescence method was used to detect thyroid stimulating hormone (TSH). Student’s t-test and chi-square test were used to analyze the difference between two groups. Pearson correlation analysis was used to assess the correlation between two variables. Results: Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were all significantly upregulated in PIH+SCH group compared with those in normal group and PIH+ non-SCH groups (all p < 0.05) and SCH had a close relationship with SBP (r 2= 0.2163, p = 0.0002). The incidences of postpartum hemorrhage, premature delivery, abortion, FGR, and pregnancy anemia were all cleary increased in PIH+non-SCH, and PIH+SCH groups, compared with those in normal group, respectively (8.3, 10, 13.3, 1 8.3, 23.3; 13.3, 23.3, 26.7, 35, and 36.7 vs.1.7, 5, 3.3, 1.7, and 5.1 (all p < 0.05). The incidences of premature delivery, abortion, FGR, and pregnancy anemia were significantly higher in PIH+SCH group than PIH+non-SCH group (23.3, 26.7, 35, and 36.7 vs. 10, 13.3, 18.3, 23.3 (all p < 0.05). Moreover, serum TSH level was significantly increased in high gestational week group compared with low gestational week group (6.86 ± 0.78 vs. 5.79 ± 0.45, p < 0.05) and SBP, DBP, and MAP were all remarkably elevated in high gestational week group compared with low gestational week group (167.6 ± 12.4 vs. 150.9 ± 10.8; 108.5 ± 11.4 vs. 95.2 ± 11.2; 121.8 ± 13.6 vs. 110.0 ± 12.3 (all p < 0.05). In addition, compared with those in low TSH group, the incidences of postpartum hemorrhage, premature delivery, abortion, FGR, and pregnancy anemia were all obviously increased in high TSH group (all p < 0.05). Conclusion: SCH had a close association with PIH and poor prognosis during pregnancy.

Key words:  Subclinical hypothyroidism      Pregnancy-induced hypertension syndrome      Thyroid stimulating hormone      Systolic blood pressure.     
Published:  15 February 2020     
*Corresponding Author(s):  L.Y. Tang     E-mail:  tanglongy909@126.com

Cite this article: 

W.X. Chen, L.Y. Tang. Relationship between subclinical hypothyroidism during pregnancy and hypertensive disorder complicating pregnancy and its poor prognosis. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(1): 111-116.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.01.4975     OR     https://ceog.imrpress.com/EN/Y2020/V47/I1/111

Figure 1.  — Relationship between SCH during pregnancy and PIH. (A) the serum level of TSH in three groups. (B) Relationship between SCH and SBP. (C) Relationship between SCH and DBP. (D) Relationship between SCH and MAP

Table 1  — The baseline information of the three groups.
Characteristics PIH+ SCH
(n = 60)
PIH+ non-SCH
(n= 60)
Normal group
(n = 60)
P value
Age (year) 27.9±5.9 27.5±6.2 28.2±6.7 >0.05
Nation
Han 58 55 57 >0.05
Minority 2 5 3
Registered residence
Urban 30 32 27 >0.05
Rural 30 28 33
Gestational week 28.5±6.9 28.9±7.1 26.3±6.4 >0.05
BMI (kg/m2) 27.2±5.4 28.2±4.3 28.4±6.4 >0.05
Table 2  — Arterial blood pressure in three groups.
SBP(mmHg) DBP(mmHg) MAP(mmHg)
Normal group 113.3+10.4 86.4+7.9 90.4+8.2
PIH+ non-SCH 147.2+5.6a 95+3.7a 105.7+4.1a
PIH+ SCH group 158.4+6.5ab 101.2+3.4ab 115.3+3.9ab
Table 3  — Comparison of pregnancy outcome between three groups.
Normal group (n=60) PIH+non-SCH (n=60) PIH+SCH group (n=60)
Postpartum hemorrhage 1 (1.7) 5 (8.3)a 8 (13.3)a
Premature delivery 3 (5) 6 (10)a 14 (23.3)ab
Abortion 2 (3.3) 8 (13.3)a 16 (26.7)ab
FGR 1 (1.7) 11 (18.3)a 21 (35)ab
Placental abruption 1 (1.7) 3 (5.1) 4 (6.8)
Pregnancy anemia 3 (5.1) 14 (23.3)a 22 (36.7)ab
Table 4  — Comparison of pregnancy outcome in different TSH level.
Low TSH group (n=32) High TSH group (n=28)
Postpartum hemorrhage 2 (6.3) 6 (21.4)a
Premature delivery 3 (9.4) 11 (39.3)a
Abortion 4 (12.5) 12 (42.9)a
FGR 5 (15.6) 16 (57.1)a
Placental abruption 2 (6.3) 2 (7.1)
Pregnancy anemia 6 (18.8) 16 (57.1)a
Figure 2.  — TSH level and arterial blood pressure in different gestational weeks. (A) the serum level of TSH in two groups. (B) SBP in two groups. (C) DBP in two groups. (D) MAP in two groups.

[1] Moodley J.: “Potentially increasing rates of hypertension in women of childbearing age and during pregnancy—be prepared!”. Cardiovasc. J. Afr., 2011, 22, 330.
[2] Conti E., Zezza L., Ralli E., Caserta D., Musumeci M.B., Moscarini M., Autore C Volpe M.: “Growth factors in preeclampsia: a vascular disease model. A failed vasodilation and angiogenic challenge from pregnancy onwards?”. Cytokine Growth Factor Rev.. 2013, 24, 411.
[3] Heimrath J., Czekanski A., Krawczenko A., Dus D.: “The role of endothelium in the pathogenesis of pregnancy-induced hypertension”. Postepy Hig. Med. Dosw.(Online), 2007, 61, 48.
[4] Medici M., Visser W.E., Visser T.J., Peeters R.P.: “Genetic determination of the hypothalamic-pituitary-thyroid axis: where do we stand?” Endocr. Rev., 2015, 36, 214.
[5] Leow M.K. : “A Review of the Phenomenon of Hysteresis in the Hypothalamus-Pituitary-Thyroid Axis”. Front. Endocrinol.(Lausanne), 2016, 7, 64.
[6] Jabbar A., Pingitore A., Pearce S.H., Zaman A., Iervasi G., Razvi S. : “Thyroid hormones and cardiovascular disease”. Nat. Rev. Cardiol., 2017, 14, 39-55.
[7] Sun X., Sun Y., Li W.C., Chen C.Y., Chiu Y.H., Chien H.Y., Wang Y.: “Association of thyroid-stimulating hormone and cardiovascular risk factors”. Intern. Med., 2015, 54, 2537.
[8] Ojamaa K., Balkman C Klein I.L.: “Acute effects of triiodothyronine on arterial smooth muscle cells”. Ann. Thorac. Surg.. 1993, 56, S61.
[9] Broderick T.J., Wechsler A.S.: “Triiodothyronine in cardiac surgery”. Thyroi., 1997, 7, 133.
[10] Gonzalez Gil L., de la Sierra A.: “Prevalence of hypertension and other cardiovascular risk factors in subjects with subclinical hypothyroidism”. Med. Clin.(Barc.), 2017, 148, 35.
[11] Arshad A.R., Tipu H.N Paracha A.I.: “The impact of hypertension on lipid parameters in type 2 diabetes”. J. Pak. Med. Assoc.. 2016, 66, 1262.
[12] Feng X., Cao X., Zhao S., Wang X., Hua X Chen L.: “Exposure of Pregnant Mice to Perfluorobutanesulfonate Causes Hypothyroxinemia and Developmental Abnormalities in Female Offspring”. Toxicol. Sci.. 2017, 155, 409.
[13] Gomez-Zamudio J.H., Mendoza-Zubieta V., Ferreira-Hermosillo A., Molina-Ayala M.A., Valladares-Salgado A., Suarez-Sanchez F ., et al.: “High Thyroid-stimulating Hormone Levels Increase Proinflammatory and Cardiovascular Markers in Patients with Extreme Obesity”. Arch. Med. Res.. 2016, 47, 476.
[14] Moleti M., Trimarchi F Vermiglio F.: “Thyroid physiology in pregnancy”. Endocr. Pract.. 2014, 20, 589.
[15] Nazarpour S., Ramezani Tehrani F., Simbar M., Azizi F.: “Thyroid dysfunction and pregnancy outcomes”. Iran J. Reprod. Med.. 2015, 13, 387.
[16] Voigtlander R Fuhrer D.: “Subclinical hypothyroidism laboratory finding or disease?”. Dtsch. Med. Wochenschr., 2016, 141, 1134.
[17] Wadzinski T.L., Geromini K., McKinley Brewer J., Bansal R., Abdelouahab N., Langlois M.F., et al.: “Endocrine disruption in human placenta: expression of the dioxin-inducible enzyme, CYP1A1, is correlated with that of thyroid hormone-regulated genes”. J. Clin. Endocrinol. Metab., 2014, 99, E2735.
[18] Nishioka E., Hirayama S., Ueno T., Matsukawa T., Vigeh M., Yokoyama K., et al.: “Relationship between maternal thyroid-stimulating hormone (TSH) elevation during pregnancy and low birth weight: a longitudinal study of apparently healthy urban Japanese women at very low risk”. Early Hum. Dev.. 2015, 91, 181.
[19] Andersen S.L., Laurberg P., Wu C.S Olsen J.: “Attention deficit hyperactivity disorder and autism spectrum disorder in children born to mothers with thyroid dysfunction: a Danish nationwide cohort study”. BJOG. 2014, 121, 1365.
[20] Anthony J., Damasceno A Ojjii D.: “Hypertensive disorders of pregnancy: what the physician needs to know”. Cardiovasc. J. Afr.. 2016, 27, 104.
[21] Chulkov V.S., Sinitsin S.P Vereina N.K.: “Prognostic Value of Central Aortic Pressure in Pregnant Women With Hypertension”. Kardiologiia. 2015, 55, 29.
[22] Yuan T., Zhang T Han Z.: “Placental vascularization alterations in hypertensive disorders complicating pregnancy (HDCP) and small for gestational age with HDCP using three-dimensional power doppler in a prospective case control study”. BMC Pregnancy Childbirth. 2015, 15, 240.
[23] Visentin S., Londero A.P., Bellamio B., Giunta G., Cosma C., Faggian D., et al.: “Fetal Endothelial Remodeling in Late-Onset Gestational Hypertension”. Am. J. Hypertens., 2016, 29, 273.
[24] Marvisi M., Balzarini L., Mancini C., Mouzakiti P.: “Thyroid gland and pulmonary hypertension. What’s the link?”. Panminerva Med.. 2013, 55, 93.
[25] Siviero-Miachon A.A., Spinola-Castro A.M Guerra-Junior G.: “Detection of metabolic syndrome features among childhood cancer survivors: a target to prevent disease”. Vasc. Health Risk Manag.. 2008, 4, 825.
[26] Sinha R., Yen P.M. : “Cellular Action of Thyroid Hormone”. In: De Groot L.J., Chrousos G., Dungan K., Feingold K.R., Grossman A., Hershman J.M., et al. (eds). South Dartmouth (MA): Endotext, 2000.
[27] Castillo Palma M.J., Garcia Hernandez F.J., Montero Benavides P., Gonzalez Leon R., Ocana Medina C., Sanchez Roman J.: “Thyroid dysfunction in patients with pulmonary arterial hypertension. A cohort study of 58 patients”. Med. Clin.(Barc.), 2009, 132, 695.
[28] Midgley J.E Hoermann R.: “Measurement of total rather than free thyroxine in pregnancy: the diagnostic implications”. Thyroi., 2013, 23, 259.
[29] Wang C.Y., Chang T.C., Chen M.F.: “Associations between subclinical thyroid disease and metabolic syndrome”. Endocr. J., 2012, 59, 911.
[30] Sieroszewski P Guzowski G.: “Prognostic value of the uterine doppler velocimetry at 20-24 gestation weeks for PIH and IUGR development in pregnancy”. Ginekol. Pol., 2005, 76, 348.
[31] Matsuda R., Fujimoto T., Tamura K., Motoyama Y., Park Y.S Nakase H.: “Case of postpartum intracerebral hemorrhage due to pregnancy induced hypertension”. No. Shinkei Geka. 2011, 39, 1159.
[32] Glinoer D., Spencer C.A.: “Serum TSH determinations in pregnancy: how, when and why?” Nat. Rev. Endocrinol., 2010, 6, 526.
[33] Gur E.B., Karadeniz M., Inceefe H., Tatar S., Turan G.A., Genc M., Guclu S.: “Thyroid antibodies in euthyroid and subclinical hypothyroidic pregnant women with autoimmune hypothyroidism: effects on hematological parameters and postpartum hemorrhage”. Ginekol.Pol., 2015, 86, 666.
[34] Liu H., Shan Z., Li C., Mao J., Xie X., Wang W., et al.: “Maternal subclinical hypothyroidism, thyroid autoimmunity, and the risk of miscarriage: a prospective cohort study”. Thyroid, 2014, 24, 1642.
[35] Yu X., Chen Y., Shan Z., Teng W., Li C., Zhou W., et al.: “The pattern of thyroid function of subclinical hypothyroid women with levothyroxine treatment during pregnancy”. Endocrine, 2013, 44, 710.
[36] De Zoysa E., Hettiarachchi M., Liyanage C.: “Urinary iodine and thyroid determinants in pregnancy: a follow up study in Sri Lanka”. BMC Pregnancy Childbirth, 2016, 16, 303.
[1] N. Al-Husban, A. Hababeh, M. Al-Kasasbeh, R. Odeh, M. Shaheen, D. Moughrabi, D. Zabalawi. Thyroid stimulating hormone (TSH) level variations in early pregnancy and feto-maternal outcome; retrospective study[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 675-680.
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