Perinatology, Selcuk University Faculty of Medicine, Konya, Turkey.
Perinatology, Kütahya University of Health Sciences, Kutahya, Turkey.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5108-5116. doi: 10.1080/14767058.2021.1875430. Epub 2021 Jan 21.
Thyroid hormones and antibodies are known to participate in angiogenesis and invasion and also thyroid hormone receptors are expressed in the placenta. We aimed to evaluate the relationship of serum levels of thyroid-stimulating hormone (TSH), thyroid hormones (TH), and anti-thyroid antibodies with abnormally invasive placenta (AIP). We also aimed to investigate whether they are related with cesarean hysterectomy and massive blood transfusion need in AIP cases.
A total of 88 pregnant patients were enrolled in this prospective case-control study (30 with AIP, 28 with non-adherent placenta previa totalis (PPT) and 30 controls). Serum TSH, thyroid hormone [T3 (triiodothyronine) and T4 (thyroxine)] and thyroid antibodies against thyroglobulin (TgAb) and thyroid peroxidase (TPOAb) levels were studied in maternal serum at initial admission to our Perinatology Unit (at early third trimester). The factors associated with increased risk of AIP, cesarean hysterectomy, massive blood transfusion, and adverse perinatal outcomes were evaluated with multiple logistic regression analysis. Adjusted odds ratios and 95% confidence intervals were also calculated.
Serum TSH and TgAb levels were significantly lower in the AIP group than both PPT and control groups ( = .01001 and 001001 respectively). Decreased serum levels of TSH (<2.16 mIU/L) and TgAb (<2.70 mIU/L) levels and high previous cesarean section rates were found to be independently associated with AIP in pregnant women with PPT (OR: 0.4, 95% CI: 0.1-0.9; = .04, OR: 0.7, 95%CI: 0.4-1.3, = .02 and OR: 0.1, 95% CI: 0.1-0.5, = .01). Decreased serum TSH and TgAb levels were found to be independently associated with an increased rate of cesarean hysterectomy and massive blood transfusion in AIP cases (OR: 3.7, 95% CI: 1.4-9.8; = .01, OR: 1.8, 95% CI: 1.1-3.1; = .03 and OR: 2.6, 95% CI: 1.0-6.5; = .05, OR: 2.2, 95% CI: 1.1-4.1 = .02). Decreased TSH and TgAb serum levels were also found to be independently associated with adverse perinatal outcomes in AIP cases (OR: 3.4, 95% CI: 1.3-11.0; = .01 and OR: 1.978, 95% CI: 2-3.6; = .03).
Decreased serum TSH and TgAb levels, and previous history of cesarean section were all found to be significantly associated with AIP in cases with PPT. We suggest that maternal serum TSH and TgAb levels can provide additional contribution to obstetric Doppler ultrasound in the diagnosis of AIP and thus can reduce the risks of unplanned cesarean hysterectomy in cases with PPT.
甲状腺激素和抗体已知参与血管生成和侵袭，甲状腺激素受体也在胎盘表达。我们旨在评估血清促甲状腺激素（TSH）、甲状腺激素（TH）和抗甲状腺抗体水平与异常侵袭性胎盘（AIP）的关系。我们还旨在研究它们是否与 AIP 病例中的剖宫产子宫切除术和大量输血需求有关。
本前瞻性病例对照研究共纳入 88 名孕妇（30 例 AIP、28 例非附着性完全性前置胎盘（PPT）和 30 例对照）。在我们的围产期病房初次入院时（妊娠晚期 3 期），研究了母体血清中的 TSH、甲状腺激素[三碘甲状腺原氨酸（T3）和甲状腺素（T4）]和甲状腺球蛋白抗体（TgAb）和甲状腺过氧化物酶抗体（TPOAb）水平。采用多因素逻辑回归分析评估与 AIP、剖宫产子宫切除术、大量输血和不良围产期结局风险增加相关的因素。还计算了调整后的优势比和 95%置信区间。
AIP 组的血清 TSH 和 TgAb 水平明显低于 PPT 和对照组（=0.01001 和 001001）。发现血清 TSH（<2.16 mIU/L）和 TgAb（<2.70 mIU/L）水平降低以及既往剖宫产率高与 PPT 孕妇的 AIP 独立相关（OR：0.4，95%CI：0.1-0.9；=0.04，OR：0.7，95%CI：0.4-1.3，=0.02 和 OR：0.1，95% CI：0.1-0.5，=0.01）。发现血清 TSH 和 TgAb 水平降低与 AIP 病例中剖宫产子宫切除术和大量输血的发生率增加独立相关（OR：3.7，95%CI：1.4-9.8；=0.01，OR：1.8，95%CI：1.1-3.1；=0.03 和 OR：2.6，95%CI：1.0-6.5；=0.05，OR：2.2，95%CI：1.1-4.1；=0.02）。发现血清 TSH 和 TgAb 水平降低与 AIP 病例中的不良围产期结局也独立相关（OR：3.4，95%CI：1.3-11.0；=0.01 和 OR：1.978，95%CI：2-3.6；=0.03）。
在 PPT 病例中，血清 TSH 和 TgAb 水平降低以及既往剖宫产史均与 AIP 显著相关。我们建议，母体血清 TSH 和 TgAb 水平可以为 AIP 的产科多普勒超声诊断提供额外贡献，从而降低 PPT 病例中计划外剖宫产子宫切除术的风险。
