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Objective <p>We aimed to assess the association of early pregnancy isolated maternal hypothyroxinemia (IMH), including persistent IMH, with adverse obstetric and perinatal outcomes.</p> Methods <p>This study was a large-scale retrospective cohort study based at a tertiary hospital in Shanghai, China between January 2013 and December 2016. Independent t-tests, chi-square tests, and stratified univariate and multivariate logistic regression analyses were performed to examine the associations between IMH and adverse pregnancy outcomes. Trend chi-square tests were used to evaluate the differences in the incidence of adverse pregnancy outcomes among the euthyroid, transient IMH, and persistent IMH groups.</p> Results <p>A total of 37,734 women with singleton pregnancies were classified into the euthyroid group (<i>n</i> = 35,733) and the IMH group (<i>n</i> = 2,001), based on thyroid function test results obtained during early pregnancy (gestational weeks 11–13). After adjusting for confounders, stratified analyses showed that IMH was associated with increased risks of gestational diabetes mellitus (GDM) primarily in women aged &lt; 35 years and those with pre-pregnancy BMI &lt; 24&#xa0;kg/m². In women aged ≥ 35 years with a BMI ≥ 24&#xa0;kg/m², IMH was associated with an elevated risk of preeclampsia. Additionally, in women aged ≥ 35 years, IMH was significantly linked to preterm birth and low birth weight (LBW). Fetal distress and macrosomia were consistently associated with IMH across all subgroups. No significant interaction effects were observed between maternal age or BMI and IMH on adverse outcomes. Trend chi-square tests indicated a linear increase in the incidence of preeclampsia, preterm birth, macrosomia, emergency cesarean section, and fetal distress across the euthyroid, transient IMH, and persistent IMH groups.</p> Conclusion <p>Early pregnancy IMH is associated with increased risks of several adverse pregnancy outcomes, and stratified analyses suggest that these risks may vary by maternal age and pre-pregnancy BMI. Both transient and persistent IMH were associated with an increased risk of adverse pregnancy outcomes, with persistent IMH related to a broader spectrum of adverse events.</p>

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The association of early pregnancy, particularly persistent isolated maternal hypothyroxinemia, with adverse obstetric and perinatal outcomes

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月30日

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  • Mengfan Song,
  • Mingtao Xiong,
  • Yu Meng

摘要

Objective

We aimed to assess the association of early pregnancy isolated maternal hypothyroxinemia (IMH), including persistent IMH, with adverse obstetric and perinatal outcomes.

Methods

This study was a large-scale retrospective cohort study based at a tertiary hospital in Shanghai, China between January 2013 and December 2016. Independent t-tests, chi-square tests, and stratified univariate and multivariate logistic regression analyses were performed to examine the associations between IMH and adverse pregnancy outcomes. Trend chi-square tests were used to evaluate the differences in the incidence of adverse pregnancy outcomes among the euthyroid, transient IMH, and persistent IMH groups.

Results

A total of 37,734 women with singleton pregnancies were classified into the euthyroid group (n = 35,733) and the IMH group (n = 2,001), based on thyroid function test results obtained during early pregnancy (gestational weeks 11–13). After adjusting for confounders, stratified analyses showed that IMH was associated with increased risks of gestational diabetes mellitus (GDM) primarily in women aged < 35 years and those with pre-pregnancy BMI < 24 kg/m². In women aged ≥ 35 years with a BMI ≥ 24 kg/m², IMH was associated with an elevated risk of preeclampsia. Additionally, in women aged ≥ 35 years, IMH was significantly linked to preterm birth and low birth weight (LBW). Fetal distress and macrosomia were consistently associated with IMH across all subgroups. No significant interaction effects were observed between maternal age or BMI and IMH on adverse outcomes. Trend chi-square tests indicated a linear increase in the incidence of preeclampsia, preterm birth, macrosomia, emergency cesarean section, and fetal distress across the euthyroid, transient IMH, and persistent IMH groups.

Conclusion

Early pregnancy IMH is associated with increased risks of several adverse pregnancy outcomes, and stratified analyses suggest that these risks may vary by maternal age and pre-pregnancy BMI. Both transient and persistent IMH were associated with an increased risk of adverse pregnancy outcomes, with persistent IMH related to a broader spectrum of adverse events.