TITLE:
Fetomaternal Outcome in Maternal Hypothyroidism Complicating Pregnancies at Paropakar Maternity and Women’s Hospital
AUTHORS:
Radhika Kunwar, Sarmila Prajapati, Anamika Jha, Anupama Bhattarai, Umesh Bahadur Bogatee
KEYWORDS:
Fetal Outcome, Maternal Outcome, Overt Hypothyroidism, Subclinical Hypothyroidism
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.12 No.11,
November
8,
2022
ABSTRACT: Background: Thyroid disorders are the most common
endocrine disorders in pregnancy accounting for 10% of subclinical
hypothyroidism in all pregnancies. Screening for hypothyroidism is essential in
all pregnant women, especially in Nepal, a low-income region where women have
an increased risk of developing iodine deficiency during pregnancy. Hence this
study is to analyze fetomaternal outcomes in maternal hypothyroidism
complicating pregnancies. Methods: This retrospective observational
study was carried out at Paropakar Maternity
and Women Hospital, a tertiary center located in Kathmandu, Nepal. The Subjects of this study were 330 antenatal
women with a singleton pregnancy with hypothyroidism admitted for
delivery in the obstetrics ward, and informed consent was obtained. Women were
chosen irrespective of age, parity,
residency, and socioeconomic status. Women with multiple pregnancies and any preexisting medical disorders including
heart disease, diabetes, and hypertension were excluded. Routine hematological
parameters and estimations of T3, T4, and thyroid stimulating hormone
(TSH) were conducted. Patients with hypothyroidism were divided into overt and
subclinical and were subsequently assessed for maternal and fetal
complications. The occurrence of maternal outcomes and perinatal outcomes were
recorded. Result: Out of 470 total hypothyroid cases, 330 were enrolled
in the study and the remaining 140 were excluded. In our study, the incidence
of hypothyroidism in pregnancy was 2.11% with 1.7% of subclinical
hypothyroidism and 0.31% of overt hypothyroidism. The mean age of the patient
was >30 years with 53.3% (n = 176) primigravida. Mostly 70.3% (n = 232) from rural areas. Pre-Eclampsia, gestational diabetes abruptio
placenta, and postpartum hemorrhage were the
adverse maternal outcome with a higher percentage of these in overt hypothyroidism which was statistically significant.
Concerning fetal outcome APGAR score iction (IUGR), NICU admission, neonatal
Respiratory distress syndrome (RDS), Intrauterine fetal death (IUFD), and
congenital anomaly were found with a
higher percentage in overt hypothyroidism. Conclusion: Since the impact of hypothyroidism on fetomaternal
morbidities have been identified so screening for hypothyroidism to be included
as a routine screening test and should be treated accordingly to improve
maternal and fetal outcome.