Prevalence and Pattern of Gestational Thyroid Dysfunction in a Population of South-East Nigerian Women.
Main Article Content
Keywords
Hypothyroidism, Pregnancy, Prevalence, Nigerian, Nutritional Iodine Status, Thyroid dysfunction
Abstract
Background: Pregnancy serves as a physiological stress test for the thyroid which often leads to dysfunction in women with limited thyroid reserves. The occurrence of gestational thyroid dysfunction is linked to unfavourable obstetric and foetal outcomes. Globally, iodine deficiency is a prominent causative factor for thyroid dysfunction. The study aimed to determine the prevalence and pattern of thyroid dysfunction among pregnant women in Enugu, South-east Nigeria.
Methodology: This hospital-based descriptive cross-sectional and observational study was conducted over six months on selected participants from pregnant women attending antenatal clinics at the study sites. Maternal clinical and demographic risk factors for thyroid dysfunction were evaluated in a cohort of 318 pregnant women. An analysis of variance (ANOVA) was performed to compare participants' thyroid status across different trimesters of pregnancy, and different thyroid and nutritional iodine states.
Result: The prevalence of thyroid dysfunction in the study population is 6.6%. Hypothyroidism was detected in 5.3% of the participants, consisting of 3.8% sub-clinical hypothyroidism and 1.6% overt hypothyroidism. Sub-clinical hyperthyroidism accounted for 1.3% of all participants; no overt hyperthyroidism was detected in this study.
Conclusion: There is a relatively high prevalence of gestational thyroid dysfunction in the study population with hypothyroidism being the predominant disorder. This highlights the need for region-specific considerations in antenatal care to facilitate early detection and effective management of gestational thyroid dysfunction, thereby mitigating potential adverse maternal and foetal outcomes.
References
2. Zhou M, Wang M, Li J, Luo X, Lei M. Effects of thyroid diseases on pregnancy outcomes. Exp Ther Med. 2019;18(6):4497–4504.
3. Reid SM, Middleton P, Cossich MC, Crowther CA, Bain E. Interventions for clinical and subclinical hypothyroidism pre‐pregnancy and during pregnancy. Cochrane Database of Systematic Reviews. 2013(5).
4. Casey BM, Leveno KJ. Thyroid disease in pregnancy. Obstetrics and Gynecology. 2006;107(4):959–962.
5. Glinoer D. The regulation of thyroid function in pregnancy: Pathways of endocrine adaptation from physiology to pathology. Endocrine Reviews. 1997;18(3):404–433.
6. Soldin OP, Tractenberg RE, Hollowell JG, Jonklaas J, Janicic N, Soldin SJ. Trimester-specific changes in maternal thyroid hormone, thyrotropin, and thyroglobulin concentrations during gestation: Trends and associations across trimesters in iodine sufficiency. Thyroid. 2004;14(12):1084–1090.
7. Altomare M, La Vignera S, Asero P, Recupero D, Condorelli RA, Scollo P, et al. High prevalence of thyroid dysfunction in pregnant women. J Endocrinol Invest. 2013;36(6):407–411.
8. Kubavat K, Patel A, Patel HL. High Prevalence of Thyroid Dysfunction Among Pregnant Women in Ahmedabad City. SOJ Gynecol Obstet Women’s Heal. 2015;1(8):676–682.
9. Ajmani SN, Aggarwal D, Bhatia P, Sharma M, Sarabhai V, Paul M. Prevalence of overt and subclinical thyroid dysfunction among pregnant women and its effect on maternal and foetal outcome. J Obstet Gynecol India. 2014;64(2):105–110.
10. Vaidya B, Anthony S, Bilous M, Shields B, Drury J, Hutchison S, et al. Detection of thyroid dysfunction in early pregnancy: Universal screening or targeted high-risk case finding? J Clin Endocrinol Metab. 2007;92(1):203–207.
11. Feki M, Omar S, Menif O, Tanfous N Ben, Slimane H, Zouari F, et al. Thyroid disorders in pregnancy: Frequency and association with selected diseases and obstetrical complications in Tunisian women. Clin Biochem. 2008;41(12):927–931.
12. Ali A. The Prevalence of Thyroid Dysfunction among Sudanese Pregnant Women. SOJ Gynecol Obstet Women’s Heal. 2015;1(1):1–4.
13. El-Bashir J, Abbiyesuku F, Aliyu I, Randawa A, Adamu R, Adamu S, et al. Prevalence of gestational thyroid disorders in Zaria, north-western Nigeria. Ann Niger Med. 2015;9(1):5–10.
14. Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, et al. Maternal Thyroid Deficiency during Pregnancy and Subsequent Neuropsychological Development of the Child. N Engl J Med. 1999;341(8):549–555.
15. Rovet JF, Willoughby KA. Maternal thyroid function during pregnancy: effects on the developing fetal brain. Maternal influences on fetal neurodevelopment: Clinical and research aspects. 2010:55-77.
16. Pop VJ, Kuijpens JL, Van Baar AL, Verkerk G, Van Son MM, De Vijlder JJ, et al. Low maternal free thyroxine concentrations during early pregnancy are associated with impaired psychomotor development in infancy. Clin Endocrinol (Oxf). 1999;50(2):149–155.
17. Assey VD, Greiner T, Mzee RK, Abuu H, Mgoba C, Kimboka S, et al. Iodine deficiency persists in the Zanzibar Islands of Tanzania. Food Nutr Bull. 2006;27(3):169–177.
18. Tenpenny KE, Trent CJ, Sutherland PA, Middlesworth L Van, Williams-Cleaves B, Braverman LE. Evidence of endemic goiter and iodine deficiency in a mountainous area of Haiti. Endocr Pract. 2009;15(6):574–578.
19. Araoye MO. Research Methodology with Statistics for Health and Social Sciences. Vol. 1, Nathadex publishers. 2004. 115–120 p.
20. Monobind Inc. Thyrotropin (TSH) Test System Product Code: 325-300. Monobind [Internet]. 2022;1–2.
21. Ab EA, Ab EA. Free Triiodothyronine (Free T3) Test System Product Code: 1325-300. 5:0–1.
22. Monobindinc. Free Thyroxine (fT4) Test System. Product code: 1225-300. Lake Forest; 2012. 4(Type 5):3–4.
23. Pino S, Fang SL, Braverman LE. Ammonium persulfate: A safe alternative oxidizing reagent for measuring urinary iodine. Clin Chem. 1996;42(2):239–243.
24. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum. Thyroid. 2017;27(3):315–389.
25. Kayode O, Odeniyi I, Olopade O, Iwuala S, Odukoya O, Fasanmade O. Iodine status in pregnant Nigerian women; Does Gestational age matters? J Clin Sci. 2019;6(1):10–15.
26. Sri SK, Kumar Korani Ratnam P. Prevalence of thyroid disorder in pregnancy and pregnancy outcome. Int Med Journal Orig Res Artic. 2017;4(3):246–249.
27. Prasad D, Nair N, K. D. A descriptive study of the prevalence of hypothyroidism among antenatal women and foetal outcome in treated hypothyroid women. Int J Reprod Contraception, Obstet Gynecol. 2016;5(11):3911–3917.
28. Saraladevi R, Kumari TN, Shreen B, Rani U. The prevalence of thyroid disorder in pregnancy. Int Arch Integr Med. 2016;3(3):83–93.
29. Abadi KK, Jama AH, Legesse AY, Gebremichael AK. Prevalence of Hypothyroidism in Pregnancy and Its Associations with Adverse Pregnancy Outcomes Among Pregnant Women in A General Hospital: A Cross Sectional Study. Int J Womens Health. 2023; 15:1481–1490.
30. Hirsch D, Levy S, Nadler V, Kopel V, Shainberg B, Toledano Y. Pregnancy outcomes in women with severe hypothyroidism. Eur J Endocrinol. 2013;169(3):313–320.
31. 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.
32. Lazarus J. Thyroid regulation and dysfunction in the pregnant patient. Endotext [Internet]. 2016 Jul 21.
33. Diéguez M, Herrero A, Avello N, Suárez P, Delgado E, Menéndez E. Prevalence of thyroid dysfunction in women in early pregnancy: Does it increase with maternal age? Clin Endocrinol (Oxf). 2016;85(6):924–930.
34. Potlukova E, Potluka O, Jiskra J, Limanova Z, Telicka Z, Bartakova J, et al. Is age a risk factor for hypothyroidism in pregnancy? An analysis of 5223 pregnant women. J Clin Endocrinol Metab. 2012;97(6):1945–1952.
35. Hollowell JG. Serum TSH, T4, and Thyroid Antibodies in the United States Population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87(2):489–499.
36. Ujowundu CO, Ukoha AI, Agha N, Nwachukwu N, Igwe KO. Assessment of current iodine status of pregnant women in a suburban area of Imo State Nigeria, twelve years after universal salt iodization. African J Biochem Res. 2010;4(3):55-60.
37. Greer LG, Casey BM, Halvorson LM, Spong CY, McIntire DD, Cunningham FG. Antithyroid antibodies and parity: Further evidence for microchimerism in autoimmune thyroid disease. Am J Obstet Gynecol. 2011;205(1):57. e1-6.
38. Stagnaro-Green A, Pearce E. Thyroid disorders in pregnancy. Nature Reviews Endocrinology. 2012;8(10):650-8.
39. Jauhari S, Agarwal M, Ali W, Singh VK, Tasleem M. Status of iodine in rural pregnant women of different trimesters in Lucknow -A cross-sectional study. Clin Epidemiol Glob Heal. 2020;8(4): 1195-1203.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open-access journal and articles are distributed under the terms of the Creative Commons Attribution Non-Commercial Share-Alike License 4.0. This licence allows users to download and share, remix, tweak and build upon the article for non-commercial purposes, so long as the original authorship is acknowledged and the new creations are licensed under identical terms.