Long term outcomes of infants born by mothers with thyroid dysfunction during pregnancy.

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Laura Lucaccioni
Monica Ficara
Valentina Cenciarelli
Alberto Berardi
Barbara Predieri
Lorenzo Iughetti https://orcid.org/0000-0003-0370-7872

Keywords

Thyroid; Pregnancy; Intra uterine growth restriction; Small for Gestational Age; Prematurity

Abstract

According to Barker’s hypothesis, sub-optimal conditions during gestation might affect the predisposition for diseases in adulthood. Alteration in endocrine functions during pregnancy, such us thyroid function or glucose metabolism, are not exempt. It is well known that subclinical hypothyroidism and thyroperoxidase antibodies-positive euthyroidism during early pregnancy are associated with increased risk of gestational diabetes mellitus and both conditions influence pregnancy outcome and newborn development and metabolism at short and long terms.


Fetal production of thyroid hormones starts from the 12th week of gestational age. The transplacental passage of maternal thyroxine (T4) is therefore essential for the fetal neurological development, especially during the first half of pregnancy.  If this passage is interrupted, such as in premature birth, neonates are more susceptible to develop impaired thyroid function, because of physiological immaturity of their hypothalamic-pituitary-thyroid axis, acute illnesses and stressful events (sepsis, invasive procedures, drugs). The aim of this review is to investigate the short and long term effects of maternal dysthyroidisms on term and preterm newborns, with particular attention to the metabolic and thyroid consequences. Metabolic syndrome, higher body mass index and greater waist circumference, seem to be more prevalent in children of TPO-Ab-positive mothers. Maternal hypothyroidism may be associated with higher risk of gestational diabetes and adverse birth outcomes, such as preeclampsia, preterm delivery, fetal death and low birth weight offspring.  In adulthood, preterm (< 37 weeks of gestational age) or low birth weight (<2.500 g) newborns  seem to be more susceptible to develop gestational diabetes, preeclampsia, type 2 diabetes mellitus and behavioral alterations. 

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References

The literature research was conducted independently by 3 investigators (LL, MF and VC) using the PubMed CENTRAL databases. The following combinations of key words were used: ( neonatal thyroid function OR preterm thyroid function) AND (metabolism in pregnancy OR pregnancy OR gestational diabetes OR thyroid function during pregnancy). The research was limited to papers published in English till September 2018. The reference lists of retrieved studies have also been reviewed to identify studies that may have not been spotted by the search strategy.

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