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Association and Predictive Accuracy of High TSH Serum Levels in First Trimester and Adverse Pregnancy Outcomes.
MedLine Citation:
PMID:  22723328     Owner:  NLM     Status:  Publisher    
Context:High serum levels of TSH have been associated with adverse pregnancy outcomes by some studies, and not by others.Objective:The aim of the study was to assess the association between high levels of TSH in the first trimester of pregnancy and adverse pregnancy outcomes; and to examine the predictive accuracy as a screening test.Setting and Participants:Serum levels of TSH were measured in a cohort of 2801 women with a singleton pregnancy attending first trimester Down syndrome screening. Information on maternal and infant outcomes was obtained through record linkage to population-based birth and hospital data. Association between high TSH (>95th and >97.5th centiles) multiple of the median levels, and risk of adverse pregnancy outcomes was evaluated using multivariable logistic regression, and the predictive accuracy of models was assessed.Main Outcomes:Rates of infants being small for gestational age (SGA), preterm birth, preeclampsia, miscarriage, and stillbirth were investigated.Results:High TSH multiple of the median levels were associated with SGA (<10th centile) [adjusted odds ratio (aOR), 1.71; 95% confidence interval (CI), 0.99-2.94]; preterm birth at less than 37 wk gestation (aOR, 2.59; 95% CI, 1.21-5.53); miscarriage (aOR, 3.66; 95% CI, 1.59-8.44); and a composite measure of any study outcome (aOR, 2.10; 95% CI, 1.23-3.59). The area under the receiver operator characteristic curves were 0.69 (95% CI, 0.65-0.73) for SGA; 0.56 (95% CI, 0.51-0.61) for preterm birth; 0.70 (95% CI, 0.61-0.79) for miscarriage; and 0.63 (95% CI, 0.60-0.65) for any adverse pregnancy outcome.Conclusions:High TSH serum levels during the first trimester of pregnancy were associated with adverse pregnancy outcomes; however, the predictive accuracy was poor. Screening for high TSH levels in the first trimester would be of no benefit to identify women at risk.
Francisco J Schneuer; Natasha Nassar; Vitomir Tasevski; Jonathan M Morris; Christine L Roberts
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-20
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  -     ISSN:  1945-7197     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Clinical and Population Perinatal Health Research (F.J.S., N.N., V.T., J.M.M., C.L.R.), Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales (NSW) 2065, Australia; Fetal Maternal Medicine (Pacific Laboratory Medicine Services) (V.T.), and Department of Obstetrics, Gynaecology and Neonatology (J.M.M., C.L.R.), Royal North Shore Hospital, St. Leonards, NSW 2065, Australia.
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