Poster Session 1
Shakeela J. Faulkner, MD (she/her/hers)
Maternal Fetal Medicine Fellow
University of Southern California/Los Angeles General Medical Center
Los Angeles, California, United States
Christopher Pham, MD
Resident Physician
Los Angeles General Medical Center
Los Angeles, California, United States
April R. Alcantara, MD
Resident Physician
Los Angeles General Medical Center
Los Angeles, California, United States
Intira Sriprasert, MD, PhD
Assistant Professor of OB/GYN
Department of Obstetrics & Gynecology Keck School of Medicine, University of Southern California
Los Angeles, California, United States
Zoey W. Agle, BS
Medical Student
Keck School of Medicine
Los Angles, California, United States
Caroline T. Nguyen, MD
Assistant Professor of Clinical Medicine, Obstetrics and Gynecology
University of Southern California
Los Angeles, California, United States
This study aimed to evaluate whether patients with uncontrolled overt hypothyroidism at initial presentation in pregnancy (thyroid stimulating hormone(TSH) >10) had differences in pregnancy outcomes in comparison to those with controlled hypothyroidism (TSH < 2.5µU/mL),and whether degree of control by gestational week(GW) 28 affected results.
Study Design:
This was a retrospective cohort study of patients with hypothyroidism in pregnancy comparing patients with a TSH less than 2.5 to patients with TSH levels greater than 10 at the initiation of prenatal care. Patients with a TSH > 10 were separated based on whether control was obtained by GW 28 weeks (TSH < 2.5), to evaluate potential effects of controlling overt hypothyroidism during pregnancy.
Results:
There was a significant difference in rates of gestational hypertension and preeclampsia. For patients with controlled hypothyroidism, overt hypothyroidism that became controlled, and overt hypothyroidism that remained uncontrolled the rates of gestational hypertension were 2.7%, 5.56%, and 21.4%(p 0.03), respectively. The rates of preeclampsia followed a similar pattern with the rates of preeclampsia increasing as the control of hypothyroidism worsened, 6.85%, 22.2%, and 35.7%(p 0.01). There were no significant differences in miscarriage, preterm delivery, NICU admission, gestational diabetes, stillbirth or postpartum hemorrhage. When considering the past medical history, there was a significant difference in the rates of a history of gestational hypertension/preeclampsia across the groups; no differences in the rates of chronic hypertension. There were no significant differences between a history of gestational hypertension/preeclampsia and preeclampsia or gestational hypertension in the current pregnancy.
Conclusion:
We observed a dose response with the degree of hypothyroidism control by GW 28 and rates of preeclampsia and gestational hypertension, suggesting that controlling overt hypothyroidism may reduce risk of complication of preeclampsia and gestational hypertension, but risks remain elevated compared to those who are euthyroid initially.
