Measuring thyroid peroxidase antibodies on the day nulliparous women present for management of miscarriage: a descriptive cohort study

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• 作者：Mathis Grossmann (6)
  Rudolf Hoermann (6)
  Claire Francis (7)
  Emma J Hamilton (6)
  Aye Tint (6)
  Tu’uhevaha Kaitu’u-Lino (7) (9)
  Kent Kuswanto (7)
  Martha Lappas (7)
  Ken Sikaris (8)
  Jeffery D Zajac (6)
  Michael Permezel (7)
  Stephen Tong (7) (9)
  
• 关键词：Thyroid peroxidase antibodies ; Miscarriage ; Vitamin D ; Thyroid autoimmunity
• 刊名：Reproductive Biology and Endocrinology
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：11
• 期：1
• 全文大小：144KB
• 参考文献：1. Thangaratinam S, Tan A, Knox E, Kilby MD, Franklyn J, Coomarasamy A: Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. / BMJ 2011, 342:d2616. j.d2616">CrossRef
  2. Poppe K, Glinoer D: Thyroid autoimmunity and hypothyroidism before and during pregnancy. / Hum Reprod Update 2003,9(2):149-61. CrossRef
  3. Prummel MF, Wiersinga WM: Thyroid autoimmunity and miscarriage. / Eur J Endocrinol 2004,150(6):751-55. je.0.1500751">CrossRef
  4. Stagnaro-Green A, Glinoer D: Thyroid autoimmunity and the risk of miscarriage. / Best Pract Res Clin Endocrinol Metab 2004,18(2):167-81. j.beem.2004.03.007">CrossRef
  5. Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H: Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. / J Clin Endocrinol Metab 2006,91(7):2587-591. jc.2005-1603">CrossRef
  6. Abbassi-Ghanavati M, Casey BM, Spong CY, McIntire DD, Halvorson LM, Cunningham FG: Pregnancy outcomes in women with thyroid peroxidase antibodies. / Obstet Gynecol 2010,116(2 Pt 1):381-86. CrossRef
  7. Cleary-Goldman J, Malone FD, Lambert-Messerlian G, Sullivan L, Canick J, Porter TF, Luthy D, Gross S, Bianchi DW, D'Alton ME: Maternal thyroid hypofunction and pregnancy outcome. / Obstet Gynecol 2008,112(1):85-2. CrossRef
  8. Barrett H, McElduff A: Vitamin D and pregnancy: an old problem revisited. / Best Pract Res Clin Endocrinol Metab 2010,24(4):527-39. j.beem.2010.05.010">CrossRef
  9. Holick MF: Vitamin D deficiency. / N Engl J Med 2007,357(3):266-81. CrossRef
  10. Kivity S, Agmon-Levin N, Zisappl M, Shapira Y, Nagy EV, Danko K, Szekanecz Z, Langevitz P, Shoenfeld Y: Vitamin D and autoimmune thyroid diseases. / Cell Mol Immunol 2011,8(3):243-47. CrossRef
  11. Goswami R, Marwaha RK, Gupta N, Tandon N, Sreenivas V, Tomar N, Ray D, Kanwar R, Agarwal R: Prevalence of vitamin D deficiency and its relationship with thyroid autoimmunity in Asian Indians: a community-based survey. / Br J Nutr 2009,102(3):382-86. CrossRef
  12. Moffett A, Loke C: Immunology of placentation in eutherian mammals. / Nat Rev Immunol 2006,6(8):584-94. CrossRef
  13. Tierney K, Delpachitra P, Grossmann M, Onwude J, Sikaris K, Wallace EM, Hamilton EJ, Tong S: Thyroid function and autoantibody status among women who spontaneously deliver under 35 weeks of gestation. / Clin Endocrinol (Oxf) 2009,71(6):892-95. j.1365-2265.2009.03569.x">CrossRef
  14. Goddijn M, Leschot NJ: Genetic aspects of miscarriage. / Baillieres Best Pract Res Clin Obstet Gynaecol 2000,14(5):855-65. CrossRef
  15. Tong S, Ngian GL, Onwude JL, Permezel M, Saglam B, Hay S, Konje JC, Marczylo TH, Fleming G, Walker SP: Diagnostic accuracy of maternal serum macrophage inhibitory cytokine-1 and pregnancy-associated plasma protein-A at 6-0 weeks of gestation to predict miscarriage. / Obstet Gynecol 2012,119(5):1000-008. CrossRef
  
• 作者单位：Mathis Grossmann (6)
  Rudolf Hoermann (6)
  Claire Francis (7)
  Emma J Hamilton (6)
  Aye Tint (6)
  Tu’uhevaha Kaitu’u-Lino (7) (9)
  Kent Kuswanto (7)
  Martha Lappas (7)
  Ken Sikaris (8)
  Jeffery D Zajac (6)
  Michael Permezel (7)
  Stephen Tong (7) (9)
  
  6. Department of Medicine, Austin Health, University of Melbourne, Studley Road, Heidelberg, Victoria, 3084, Australia
  7. Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Studley Road, Heidelberg, Victoria, 3084, Australia
  9. Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Studley Road, Heidelberg, Victoria, 3084, Australia
  8. Melbourne Pathology, 103 Victoria Parade, Collingwood, Victoria, 3066, Australia
  

文摘

Background There has been recent evidence suggesting the presence of anti-thyroid peroxidase antibodies (TPOAb) increases the risk of miscarriage, and levothyroxine can rescue miscarriages associated with TPOAb. We propose the most clinically pragmatic cohort to screen for TPOAb are women presenting for management of a missed miscarriage and have never birthed a liveborn. We measured serum TPOAb among nulliparous women presenting for management of miscarriage, and compared levels with women who have had 2 or more livebirths (and never miscarried). Given its potential role in immunomodulation, we also measured Vitamin D levels. Methods We performed a prospective descriptive cohort study at a tertiary hospital (Mercy Hospital for Women, Victoria, Australia). We measured TPOAb and Vitamin D levels in serum obtained from 118 nulliparous women presenting for management of miscarriage, and 162 controls with 2 or more livebirths (and no miscarriages). Controls were selected from a serum biobank prospectively collected in the first trimester at the same hospital. Results Nulliparous women with 1 or more miscarriages had higher thyroid peroxidase antibody (TPOAb) levels than those with 2 or more livebirths; TPOAb in miscarriage group was 0.3 mIU/L (interquartile range [IR]: 0.2-0.7) vs 0.2 mIU/L among controls (IR 0.0-0.5; p-lt;-.0001). We confirmed TPOAb levels were not correlated with serum human chorionic gonadotrophin (hCG) concentrations in either the miscarriage or control groups. In contrast, thyroid stimulating hormone, fT3 and fT4 levels (thyroid hormones) either trended towards a correlation, or were significantly correlated with serum hCG levels in the two groups. Of the entire cohort that was predominantly caucasian, only 12% were Vitamin D sufficient. Low Vitamin D levels were not associated with miscarriage. Conclusions We have confirmed the association between miscarriage and increased TPOAb levels. Furthermore, it appears TPOAb levels in maternal blood are not influenced by serum hCG levels. Therefore, we propose the day nulliparous women present for management for miscarriage is a clinically relevant, and pragmatic time to screen for TPOAb.