Prevalence of hypothyroidism in a hospital based sample of pregnant kashmiri women with recurrent abortions and pregnancy outcome

Background: Pregnancy has a profound effect on the thyroid gland and its function. Hypothyroidism complicates 0.3-0.7% of all pregnancies. Most common cause of hypothyroidism in pregnancy is Hashimoto’s thyroiditis. Women with thyroid autoimmunity are twice as likely to experience spontaneous miscarriages. Hence, there is a need to screen for subclinical hypothyroidism and thyroid autoimmunity in pregnancy, especially in women with a history of miscarriages. Objectives:(a) To assess prevalence of hypothyroidism in a hospital based sample of Kashmiri women with recurrent abortions and perinatal outcome after receiving treatment. (b) Is universal screening needed or not? Methodology: It was a prospective hospital based multiple unit study. Two groups were formulated, one group comprising of 100 pregnant women with a history of two or more recurrent abortions were labelled as case group while as another group comprising of 100 pregnant patients with one successful pregnancy were labelled as controls. Prevalence of subclinical hypothyroidism, thyroid auto immunity and maternal and fetal complications were analysed in the groups with appropriate statistical methods. Results: In our study the prevalence of subclinical hypothyroidism in case group with recurrent miscarriage was 27%. Thyroid autoimmunity was present in 31% of cases while as in controls it was 18 %, p-value statistically significant (0.033). Also mean TSH of cases and control groups were not significant (0.893). Complications between cases and controls were statistically not significant after receiving treatment. However postdatism was statistically significant (p value 0.024). Another subgroup was created within case group labelled TPO positive and TPO negative groups, TPO positive were 31 in number, while 61 were TPO negative. Statistical comparison was drawn between these two groups. The mean TSH in TPO positive group and TPO negative group was statistically significant (p value 0.001). With respect to complications between TPO positive and TPO negative groups, there was no statistical significance. However, IUGR was statistically significant with p value of 0.002. Hypothyroidism was statistically significant with 27 in TPO positive and none in TPO negative, p value 0.001. Conclusion: The prevalence of subclinical hypothyroidism and thyroid autoimmunity was higher in pregnant women with a history of recurrent abortion compared with a healthy pregnant control population. Following L-T4 treatment, there was no difference in the prevalence of miscarriage between hypothyroid and euthyroid individuals in TPO positive women. All euthyroid women with thyroid autoimmunity should be treated with LT4 to achieve a favourable maternal and perinatal outcome.