Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2019

Open Access 01-12-2019 | Pre-Eclampsia | Research article

Association between thyroid-stimulating hormone and maternal hemodynamics in hypertensive disorders of pregnancy: an observational study

Authors: Yu Liu, Bo Gao, Xin Zeng, Jing Yang, Lei Zhang, Ganwei Xu, Ruizhe Jia, Zhengfeng Xu

Published in: BMC Pregnancy and Childbirth | Issue 1/2019

Login to get access

Abstract

Background

Hypertensive disorders of pregnancy (HDP) are characterized by hemodynamic disturbances. Altered thyroid function is a risk factor for poor outcomes of pregnancy. However, the associations between thyroid function biomarkers and maternal hemodynamics during pregnancy in HDP remain unclear.

Methods

From January 2016 to January 2018, pregnant women diagnosed with HDP admitted to the Nanjing Maternity and Child Health Care Hospital were prospectively enrolled in the third trimester. Normally distributed variables were expressed as mean ± standard deviation and skewed variables were expressed as median (25th percentile, 75th percentile). Correlations between thyroid-stimulating hormone (TSH) or free thyroxine (FT4) and maternal hemodynamic parameters were assessed by Pearson’s correlation coefficient and 95% confidence interval (95%CI). Bonferroni’s correction for multiple correlations was performed. Logistic regression models with odd ratio (OR) and 95%CI were applied to confirm the associations.

Results

A total of 163 third-trimester pregnant women with HDP with a mean gestational age of 35.62 ± 2.83 weeks were recruited. The infant birth weight of patients with elevated TSH levels was lower than that of patients with normal TSH levels (2635 ± 867 g vs. 3037 ± 673 g, p = 0.002). Reduced cardiac output (CO) was defined as CO < 3.5 L/min. The infant birth weight of patients with reduced CO was lower than that of patients with normal CO (2250 ± 510 g vs. 2890 ± 774 g, p = 0.002). TSH levels were significantly and negatively correlated with CO (r = − 0.260, 95%CI: − 0.392- -0.103, p < 0.001). FT4 levels were not significantly correlated with any of the maternal hemodynamic parameters (all p > 0.05). TSH level (OR = 1.371, 95%CI: 1.086–1.733, p = 0.008) was confirmed associated with reduced CO in the logistic regression analysis.

Conclusions

Elevated TSH levels are associated with reduced CO in HDP during the third trimester.
Appendix
Available only for authorised users
Literature
1.
Medici M, Korevaar T, Schalekamp-Timmermans S, Gaillard R, de Rijke YB, Visser WE, et al. Maternal early-pregnancy thyroid function is associated with subsequent hypertensive disorders of pregnancy: the generation R study. J Clin Endocrinol Metab. 2014;99:E2591–8.CrossRef
2.
Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet. 2010;376:631–44.CrossRef
3.
Armaly Z, Jadaon JE, Jabbour A, Abassi ZA. Preeclampsia: Novel Mechanisms and Potential Therapeutic Approaches. Front Physiol. 2018;9:973.CrossRef
4.
Chen J, Khalil RA. Matrix Metalloproteinases in Normal Pregnancy and Preeclampsia. Prog Mol Biol Transl Sci. 2017;148:87–165.CrossRef
5.
Hod T, Ana Sofia Cerdeira S, Karumanchi A. Molecular Mechanisms of Preeclampsia. Cold Spring Harb Perspect Med. 2015;5:a023473.CrossRef
6.
Possomato-Vieira JS, Khalil RA. Mechanisms of Endothelial Dysfunction in Hypertensive Pregnancy and Preeclampsia. Adv Pharmacol. 2016;77:361–431.CrossRef
7.
Ilekis JV, Tsilou E, Fisher S, Abrahams VM, Soares MJ, Cross JC, et al. Placental Origins of Adverse Pregnancy Outcomes: Potential Molecular Targets- An Executive Workshop Summary of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Am J Obstet Gynecol. 2016;215:S1–S46.CrossRef
8.
Spradley FT, Palei AC, Granger JP. Increased risk for the development of preeclampsia in obese pregnancies: weighing in on the mechanisms. Am J Physiol Regul Integr Comp Physiol. 2015;309:R1326–43.CrossRef
9.
Barjaktarovic M, Korevaar TIM, Chaker L, Jaddoe VWV, de Rijke YB, Visser TJ, et al. The association of maternal thyroid function with placental hemodynamics. Hum Reprod. 2017;32:653–61.PubMed
10.
Bamfo JE, Kametas NA, Chambers JB, Nicolaides KH. Maternal cardiac function in normotensive and pre-eclamptic intrauterine growth restriction. Ultrasound Obstet Gynecol. 2008;32:682–6.CrossRef
11.
Prefumo F, Muiesan ML, Perini R, Paini A, Bonzi B, Lojacono A, Agabiti-Rosei E, Frusca T. Maternal cardiovascular function in pregnancies complicated by intrauterine growth restriction. Ultrasound Obstet Gynecol. 2008;31:65–71.CrossRef
12.
Valensise H, Novelli GP, Vasapollo B, Borzi M, Arduini D, Galante A, Romanini C. Maternal cardiac systolic and diastolic function: relationship with uteroplacental resistances. A Doppler and echocardiographic longitudinal study. Ultrasound Obstet Gynecol. 2000;15:487–97.CrossRef
13.
Ghi T, Kulevak M, Youssef A, Maroni E, Nanni M, Pilu G, Rizzo N, Pelusi G. Maternal cardiac function in complicated twin pregnancy: a longitudinal study. Ultrasound Obstet Gynecol. 2011;38:581–5.CrossRef
14.
Tay J, Lin F, Masini G, Bennett PR, McEniery CM, Ian B. Wilkinson, et al. Early and late preeclampsia are characterized by high cardiac output, but in the presence of fetal growth restriction, cardiac output is low: insights from a prospective study. Am J Obstet Gynecol. 2018;S0002937818306501.
15.
Wilson KL, Casey BM, McIntire DD, Halvorson LM, Cunningham FG. Subclinical thyroid disease and the incidence of hypertension in pregnancy. Obstet Gynecol. 2012;119:315–20.CrossRef
16.
Aggarawal N, Suri V, Singla R, Chopra S, Sikka P, Shah VN, Bhansali A. Pregnancy outcome in hyperthyroidism: a case control study. Gynecol Obstet Investig. 2014;77:94–9.CrossRef
17.
Vasilopoulou E, Loubiere LS, Lash GE, Ohizua O, McCabe CJ, Franklyn JA, Kilby MD, Chan SY. Triiodothyronine regulates angiogenic growth factor and cytokine secretion by isolated human decidual cells in a cell-type specific and gestational age-dependent manner. Hum Reprod. 2014;29:1161–72.CrossRef
18.
Carneiro-Ramos MS, Diniz GP, Almeida J, Vieira RLP, Pinheiro SVB, Santos RA, Barreto-Chaves MLM. Cardiac angiotensin II type I and type II receptors are increased in rats submitted to experimental hypothyroidism. J Physiol. 2007;583:213–23.CrossRef
19.
Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy. 2001;20:IX–XIV.CrossRef
20.
McIntyre JPR, Ellyett KM, Mitchell EA, Quill GM, Thompson JMD, Stewart AW, et al. Validation of thoracic impedance cardiography by echocardiography in healthy late pregnancy. BMC Pregnancy Childbirth. 2015;15:70.CrossRef
21.
Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European thyroid association guidelines for the Management of Subclinical Hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014;3:76–94.CrossRef
22.
Liu Y, Chen H, Jing C, Li FP. The Association Between Maternal Subclinical Hypothyroidism and Growth, Development, and Childhood Intelligence: A Meta-analysis. J Clin Res Pediatr Endocrinol. 2018;10:153–61.CrossRef
23.
Al Shanqeeti SA, Alkhudairy YN, Alabdulwahed AA, Ahmed AE, Al-Adham MS, Mahmood NM. Prevalence of subclinical hypothyroidism in pregnancy in Saudi Arabia. Saudi Med J. 2018;39:254–60.CrossRef
24.
Duncan Bassett JH, Williams GR. Role of Thyroid Hormones in Skeletal Development and Bone Maintenance. Endocr Rev. 2016;37:135–87.CrossRef
25.
Poppe K, Glinoer D. Thyroid autoimmunity and hypothyroidism before and during pregnancy. Hum Reprod Update. 2003;9:149–61.CrossRef
26.
Yu N, Cheng YJ, Liu LJ, Sara JDS, Cao ZY, Zheng WP, et al. What is the association of hypothyroidism with risks of cardiovascular events and mortality? A meta-analysis of 55 cohort studies involving 1,898,314 participants. BMC Med. 2017;15:21.CrossRef
27.
Shao Q, Cheng HJ, Callahan MF, Kitzman DW, Li WM, Cheng CP. Overexpression myocardial inducible nitric oxide synthase exacerbates cardiac dysfunction and beta-adrenergic desensitization in experimental hypothyroidism. Int J Cardiol. 2016;204:229–41.CrossRef
28.
29.
Biondi B. Mechanisms in endocrinology: heart failure and thyroid dysfunction. Eur J Endocrinol. 2012;167:609–18.CrossRef
30.
Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev. 2008;29:76–131.CrossRef
31.
Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001;344:501–9.CrossRef
32.
Danzi S, Klein I. Thyroid hormone and the cardiovascular system. Minerva Endocrinol. 2004;29:139–50.PubMed
33.
Roef GL, Taes YE, Kaufman J-M, Van Daele CM, De Buyzere ML, Gillebert TC, et al. Thyroid Hormone Levels Within Reference Range Are Associated with Heart Rate, Cardiac Structure, and Function in Middle-Aged Men and Women. Thyroid. 2013;23:947–54.CrossRef
34.
Gao C, Li T, Liu J, Guo Q, Tian L. Endothelial Functioning and Hemodynamic Parameters in Rats with Subclinical Hypothyroid and the Effects of Thyroxine Replacement. PLoS One. 2015;10:e0131776.CrossRef
35.
Öner T, Özdemir R, Doksöz Ö, Yozgat Y, Karadeniz C, Demirpençe S, et al. Cardiac Function in Newborns with Congenital Hypothyroidism: Association with Thyroid-Stimulating Hormone Levels. J Clin Res Pediatr Endocrinol. 2015;7:307–11.CrossRef
36.
John W, Petersen JL, Chi Y-Y, Lingis M, Williams RS, Rhoton-Vlasak A, et al. Comparison of multiple non-invasive methods of measuring cardiac output during pregnancy reveals marked heterogeneity in the magnitude of cardiac output change between women. Physiol Rep. 2017;5:e13223.CrossRef
37.
Andreas M, Kuessel L, Kastl SP, Wirth S, Gruber K, Rhomberg F, et al. Bioimpedance cardiography in pregnancy: A longitudinal cohort study on hemodynamic pattern and outcome. BMC Pregnancy and Childbirth. 2016;16:128.CrossRef
38.
Gabbe S, Niebyl J, Simpson J. Obstetrics: normal and problem pregnancies. Philadelphia: Saunders; 2012. p. 779–824.
39.
Lavie A, Ra M, Lev S, Blecher Y, Amikam U, Shulman Y, et al. Maternal cardiovascular hemodynamics in normotensive versus preeclamptic pregnancies: a prospective longitudinal study using a noninvasive cardiac system (NICaS™). BMC Pregnancy and Childbirth. 2018;18:229.CrossRef
40.
Tudoran C, Tudoran M, Vlad M, Balas M, Pop GN, Parv F. Echocardiographic evolution of pulmonary hypertension in female patients with hyperthyroidism. Anatol J Cardiol. 2018;20:174–81.PubMedPubMedCentral
Metadata
Title
Association between thyroid-stimulating hormone and maternal hemodynamics in hypertensive disorders of pregnancy: an observational study
Authors
Yu Liu
Bo Gao
Xin Zeng
Jing Yang
Lei Zhang
Ganwei Xu
Ruizhe Jia
Zhengfeng Xu
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2019
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-019-2556-4

Other articles of this Issue 1/2019

BMC Pregnancy and Childbirth 1/2019 Go to the issue

Research article

No association between early antiretroviral therapy during pregnancy and plasma levels of angiogenic factors: a cohort study

Research article

Comparison of perinatal outcomes in facilities before and after Global Network’s Helping Babies Breathe Implementation Study in Nagpur, India

Research article

Women who have not utilized health Service for Delivery in Nigeria: who are they and where do they live?

Research article

Deceleration of fetal growth rate as alternative predictor for childhood outcomes: a birth cohort study

Research article

Treatment resistant depression in women with peripartum depression

Research article

Experiences of pregnant women with a third trimester routine ultrasound – a qualitative study