Untreated hypothyroidism in pregnancy is associated with adverse maternal effects. During pregnancy, it is known to result in miscarriages (in early pregnancy), recurrent pregnancy losses, anemia, pre-eclampsia, gestational diabetes, abruptio-placenta, postpartum hemorrhage, increased cesarean sections due to fetal distress, and rarely myopathy and even congestive heart failure (CHF) in severe cases.

In the baby, Hypothyroidism results in preterm births, intrauterine growth restriction, intrauterine fetal demise, respiratory distress and increased perinatal mortality (PNM). In newborns, it leads to cognitive, neurological and developmental impairment. Thyroid hormone is critical for fetal brain development.

Symptoms of Hypothyroidism during pregnancy

Women complain of fatigue, lethargy, weight gain Constipation and feeling cold.

Treatment

American Thyroid Association recommends treatment of Pregnant women with clinical symptoms of Hypothyroidism with TSH more than 2.5 mIU/L and with low T4 levels or subclinical ( Patients with no symptoms) hypothyroidism with positive antibodies. It also recommends regular TSH monitoring of euthyroid ( Thyroid hormone levels are normal, but they have antibodies) Pregnant women throughout pregnancy. Subclinical Hypothyroidism in pregnant women who have not been treated initially should be monitored every 4 weeks with serum TSH and FT4, until 16 to 20 weeks of gestation and at least once between 26 to 32 weeks.

Endocrine society encourages TSH in “high risk” individuals and low dose thyroxine to target TSH to <2.5mIU/l. It recommends repeating the screening in the second trimester if initial screening is normal. Adequacy of hypothyroid treatment will be monitored by repeat TSH after 6 weeks of initiation of treatment and medication will be adjusted. One should try to take the thyroid medication 1 to 1.5 hours before food or 4 to 5 hours after food and avoid taking thyroid medications along with your pre-natal vitamins as it can interfere with its absorption.

Source: National Guidelines for Screening of Hypothyroidism during Pregnancy, India.

MoHFW, Government of India

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