Impact of subclinical hypothyroidism in women with recurrent early pregnancy loss

Capsule:
The high prevalence of subclinical hypothyroidism among women with recurrent early pregnancy loss did not appear to impact the live-birth rates in this population.

Authors:
Lia A. Bernardi, M.D., Ronald N. Cohen, M.D., Mary D. Stephenson, M.D., M.Sc.

Volume 100, Issue 5, Pages 1326-1331.e1, November 2013

Abstract:

Objective:
To assess the impact of subclinical hypothyroidism (SCH) in women with recurrent early pregnancy loss (REPL).

Design:
Observational cohort study.

Setting:
REPL program in an academic medical center.

Patient(s):
286 women with a history of ≥2 pregnancy losses <10 weeks. Intervention(s):
From 2004–2007, no treatment for women with SCH (thyroid-stimulating hormone [TSH] >2.5 mIU/L with a normal free thyroxine or free thyroxine index); from 2008 onward, levothyroxine treatment prepregnancy to maintain TSH ≤2.5 mIU/L.

Main Outcome Measure(s):
Live-birth rate (LBR).

Result(s):
The prevalence of SCH was 55 (19%) of 286 in this REPL cohort. The cumulative LBR was 27 (69%) of 39 for women with SCH versus 104 (74%) of 141 for euthyroid women. The per-pregnancy LBR was 34 (49%) of 69 for SCH versus 129 (58%) of 221 for euthyroid women. When the LBR was compared between treated and untreated SCH, the cumulative LBR was 17 (71%) of 24 versus 10 (67%) of 15, respectively. The per-pregnancy LBR for SCH treated versus untreated women was 22 (48%) of 46 versus 12 (52%) of 23, respectively.

Conclusion(s):
Although there was a high prevalence of SCH in the REPL cohort, there was no statistically significant difference in the subsequent live-birth rate when comparing women with SCH and euthyroid women, or treated and untreated SCH.

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