Background: CH interferes with human reproductive physiology, reduces the likelihood of pregnancy and adversely affects pregnancy and perinatal outcome. However, in subjects with early treated CH, a normal pubertal development has been reported. There are no systematic studies about fertility and pregnancy outcome in affected adults. Objective and hypotheses: Fertility and pregnancy evalutation in CH adult females. Methods: Gynecologic history was evaluated in a semistructurated questionnaire carried out by expert clinicians. The results were compared with data derived from national register of births. 155 girls with permanent CH between 1978 and 1994, in 4 italian regions, were recalled. 69 (44.6%) subjects (mean age 22.1 ± 4.4 yrs; 25 (36%) athyreosis, 32 ectopic gland (47%), 12 (17%) in situ gland) agreed to participate our study. Results: 9 pts reported 10 pregnancies (15%),3 of which terminated by abortion (1 miscarriage: 6° week of GA in 28.4 yrs pt with ectopic thyroid gland; 2 elective abortion: 4° week of GA in 20.2 yrs pt with hypoplasia, 6° week of GA in 21.3 yrs pt with athyreosis). The abortion rate was 1.45% for miscarriage (0.54% in control population), 2.9% for elective abortion (0.86% in control population).In the fullterm pregnancies the mean increase of L-T4 dose needed in each trimester was 15% (10%-20%), 15%(10%-20%) and 20%(10%-30%) respectively. TSH values >2.5 mU/L were found in 7/7 cases in the 1st trimester, in 4/7 in the 2nd, in 4/7 in the 3th. All newborn showed normal results at neonatal screening and at thyroid ultrasound. The table shows the data of live births subdivided according to maternal age. Conclusions: These preliminary data seem to indicate a normal fertility in patients with CH. The abortion rate seems to be higher than in control population. The monitoring of L-T4 dose adequacy in pregnancy is poor in our patients. These data warrant further investigation to evaluate the impact of genetic or therapeutic factors.
Fertility in adult females with congenital hypothyroidism (CH) diagnosed by neonatal screening
AVERSA, TOMMASO;DE LUCA, Filippo;
2012-01-01
Abstract
Background: CH interferes with human reproductive physiology, reduces the likelihood of pregnancy and adversely affects pregnancy and perinatal outcome. However, in subjects with early treated CH, a normal pubertal development has been reported. There are no systematic studies about fertility and pregnancy outcome in affected adults. Objective and hypotheses: Fertility and pregnancy evalutation in CH adult females. Methods: Gynecologic history was evaluated in a semistructurated questionnaire carried out by expert clinicians. The results were compared with data derived from national register of births. 155 girls with permanent CH between 1978 and 1994, in 4 italian regions, were recalled. 69 (44.6%) subjects (mean age 22.1 ± 4.4 yrs; 25 (36%) athyreosis, 32 ectopic gland (47%), 12 (17%) in situ gland) agreed to participate our study. Results: 9 pts reported 10 pregnancies (15%),3 of which terminated by abortion (1 miscarriage: 6° week of GA in 28.4 yrs pt with ectopic thyroid gland; 2 elective abortion: 4° week of GA in 20.2 yrs pt with hypoplasia, 6° week of GA in 21.3 yrs pt with athyreosis). The abortion rate was 1.45% for miscarriage (0.54% in control population), 2.9% for elective abortion (0.86% in control population).In the fullterm pregnancies the mean increase of L-T4 dose needed in each trimester was 15% (10%-20%), 15%(10%-20%) and 20%(10%-30%) respectively. TSH values >2.5 mU/L were found in 7/7 cases in the 1st trimester, in 4/7 in the 2nd, in 4/7 in the 3th. All newborn showed normal results at neonatal screening and at thyroid ultrasound. The table shows the data of live births subdivided according to maternal age. Conclusions: These preliminary data seem to indicate a normal fertility in patients with CH. The abortion rate seems to be higher than in control population. The monitoring of L-T4 dose adequacy in pregnancy is poor in our patients. These data warrant further investigation to evaluate the impact of genetic or therapeutic factors.Pubblicazioni consigliate
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