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Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death

Departments of¹ Endocrinology and Metabolism² Clinical Epidemiology, Biostatistics and Bioinformatics³ Social Science, Academic Medical Centre of the University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

(Correspondence should be addressed to N Benhadi; Email: n.benhadi{at}amc.uva.nl)

Background: To examine the relationship between maternal TSH and free thyroxine (FT₄) concentrations in early pregnancy and the risk of miscarriage, fetal or neonatal death.

Method: Cohort study of 2497 Dutch women. TSH, FT₄, and thyroid peroxidase antibodies concentrations were determined at first booking. Child loss was operationalized as miscarriage, fetal or neonatal death. Women with overt thyroid dysfunction were excluded.

Results: Twenty-seven cases of child loss were observed. The mean TSH and FT₄ level in the women with child loss was 1.48 mU/l and 9.82 pmol/l compared with 1.11 mU/l and 9.58 pmol/l in women without child loss. The incidence of child loss increased by 60% (OR=1.60 (95% confidence interval (CI): 1.04–2.47)) for every doubling in TSH concentration. This association remained after adjustment for smoking, age, parity, diabetes mellitus, hypertension, previous preterm deliveries, and previous preterm stillbirth/miscarriage (adjusted odds ratio=1.80 (95% CI: 1.07–3.03)). This was not true for FT₄ concentrations (OR=1.41 (95% CI: 0.21–9.40); P=0.724).

Conclusion: In a cohort of pregnant women without overt thyroid dysfunction, the risk of child loss increased with higher levels of maternal TSH. Maternal FT₄ concentrations and child loss were not associated.