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Hirsch D.,Institute of Endocrinology | Hirsch D.,Tel Aviv University | Levy S.,The Academic College of Tel-Aviv-Yaffo | Levy S.,Tel Aviv University | And 5 more authors.
European Journal of Endocrinology | Year: 2013

Objective: Hypothyroidism during pregnancy has been associated with adverse obstetrical outcomes. Most studies have focused on subjects with a mild or subclinical disorder. The aims of the present study were to determine the relative rate of severe thyroid dysfunction among pregnant women with hypothyroidism, identify related factors and analyse the impact on pregnancy outcomes. Design: A retrospective case series design was employed. Methods: The study group included 101 pregnant women (103 pregnancies) with an antenatal serum TSH level O20.0 mIU/l identified from the 2009-2010 computerised database of a health maintenance organisation. Data were collected from the medical records. Pregnancy outcomes were compared with those of a control group of 205 euthyroid pregnant women during the same period. Results: The study group accounted for 1.04% of all insured pregnant women with recorded hypothyroidism during the study period. Most cases had an autoimmune aetiology. All women were treated with levothyroxine (L-T4) during pregnancy. Maximum serum TSH level measured was 20.11-150 mIU/l (median 32.95 mIU/l) and median serum TSH level 0.36-75.17 mIU/l (median 7.44 mIU/l). The mean duration of hypothyroidism during pregnancy was 21.2G13.2 weeks (median 18.5 weeks); in 36 cases (34.9%), all TSH levels during pregnancy were elevated. Adverse pregnancy outcomes included abortions in 7.8% of the cases, premature deliveries in 2.9% and other complications in 14.6%, with no statistically significant differences from the control group. Median serum TSH level during pregnancy was positively correlated with the rate of abortionsCpremature deliveries and rate of all pregnancy-related complications (P!0.05). Conclusions: Abortions and premature deliveries occur infrequently in women with severe hypothyroidism. Intense follow-up and L-T4 treatment may improve pregnancy outcomes even when target TSH levels are not reached. © 2013 European Society of Endocrinology. Source

Hirsch D.,Institute of Endocrinology | Hirsch D.,Tel Aviv University | Kopel V.,Maccabi Health Care Services Central Laboratory | Nadler V.,Maccabi Health Care Services Central Laboratory | And 6 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2015

Objective: Primary hyperparathyroidism (PHPT) during pregnancy may pose considerable risks to mother and fetus. This study examined pregnancy outcomes in women with gestational PHPT in relation to clinical and laboratory parameters. Design: This study was designed as a retrospective case series. Methods: The study group included 74 women aged 20-40 years who were diagnosed with PHPT after a finding of serum calcium ≥ 10.5 mg/dL on routine screening at a health maintenance organization (2005-2013) and who became pregnant during the time of hypercalcemia (124 pregnancies). Clinical and laboratory data were collected from the files. Pregnancy outcomes were compared with 175 normocalcemic pregnant women (431 pregnancies) tested during the same period. Results: The cohort represented 0.03% of all women of reproductive age tested for serum calcium during the study period. Abortion occurred in 12 of 124 pregnancies (9.7%), and other complications occurred in 19 (15.3%) with no statistically significant differences from controls. Hypercalcemia was first detected during pregnancy in 14 of 74 women (18.9%) and before pregnancy (mean, 33.4 ± 29 mo) in 60. Serum calcium was measured antenatally in 57 of 124 pregnancies (46%); the mean level was 10.7 ± 0.6 mg/dL (median, 10.6 mg/dL). Measurement of the serum PTH level (with consequent diagnosis of PHPT) was performed during the first studied pregnancy in 17 of 74 women (23%), before pregnancy (mean, 37.8 ± 25.5 mo; median, 34 mo) in 23 (31.1%), and after delivery (mean, 54.7 ± 45.7 mo; median, 35 mo) in 34 (45.9%). Forty-three women (58.1%) underwent parathyroidectomy, six during pregnancy, without maternal or fetal complications. No difference was found in abortion or any pregnancy-related complication between patients who subsequently underwent parathyroidectomy and those who did not. No significant correlation was found between calcium level during pregnancy and pregnancy outcomes. Conclusions: Serum calcium levels are usually only mildly elevated during pregnancy in women with PHPT. A significant proportion of cases go undiagnosed. Mild hypercalcemia in gestational PHPT is generally not associated with an increased risk of obstetrical complications. Copyright © 2015 by the Endocrine Society. Source

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