Kuokkanen Satu, Seungdamrong Aimee, Santoro Nanette, Lieman Harry, Sun Fangbai, Wild Robert, Zhang Heping, Pal Lubna
Department of Obstetrics and Gynecology, NYU Long Island Grossman School of Medicine, New York, New York.
Kindbody, Inc, New York, New York.
Fertil Steril. 2025 May;123(5):873-882. doi: 10.1016/j.fertnstert.2024.12.005. Epub 2024 Dec 12.
We examined if thyroid autoimmunity is relevant to the relationship between maternal thyroid stimulating hormone (TSH) levels and pregnancy outcomes.
Retrospective cohort analysis of data from 2 randomized controlled trials (RCTs).
Participants of the Pregnancy in Polycystic Ovary Syndrome (PPCOS II, n = 746) and the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS, n = 832 with unexplained infertility) RCTs.
Pre-RCT intervention levels of TSH at threshold of ≥2.0 mU/L and thyroid peroxidase antibody (TPO-Ab) at titer threshold of ≥30 U/mL.
Live birth (primary outcome), pregnancy loss, and preterm birth (secondary outcomes). Generalized linear model (GLM) analyses examined the relationship between exposure to TSH and TPO-Ab at specified thresholds with the specified outcomes; covariates adjusted for included age, body mass index, race, ethnicity, education, smoking, duration of infertility, PCOS (vs. unexplained infertility), and randomized intervention arm in the respective RCTs.
On adjusted analyses, live birth was significantly reduced in the exposed population (those with TSH ≥2.0 mU/L and TPO-Ab ≥30 U/mL, n = 117/1,578, 7.4%, adjusted risk ratio [ARR]: 0.55; 95% CI: 0.35-0.87) compared with the unexposed (those with TSH <2.0 mU/L and TPO-Ab <30 U/mL, n = 865/1,578, 54.8%). Furthermore, the risk of pregnancy loss and of early preterm birth (<32 weeks) was significantly higher in the exposed compared with the unexposed (ARR for pregnancy loss was 1.66; 95% CI: 1.14-2.42, and ARR for early preterm birth was 4.82, 95% CI: 1.53-15.19).
In women with TPO-Ab titers ≥30 U/mL, pregnancy outcomes may be compromised at TSH threshold of ≥2 mU/L. These findings of an interaction between TSH and TPO for pregnancy outcomes merit further investigation in prospective studies.
NCT00719186 and NCT01044862.
我们研究了甲状腺自身免疫是否与孕妇促甲状腺激素（TSH）水平和妊娠结局之间的关系相关。
对两项随机对照试验（RCT）的数据进行回顾性队列分析。
多囊卵巢综合征妊娠试验（PPCOS II，n = 746）和卵巢刺激多胎妊娠评估试验（AMIGOS，n = 832，不明原因不孕）的RCT参与者。
随机对照试验前干预时TSH水平≥2.0 mU/L阈值和甲状腺过氧化物酶抗体（TPO-Ab）滴度≥30 U/mL阈值。
活产（主要结局）、妊娠丢失和早产（次要结局）。广义线性模型（GLM）分析检验了在特定阈值下暴露于TSH和TPO-Ab与特定结局之间的关系；调整的协变量包括年龄、体重指数、种族、民族、教育程度、吸烟情况、不孕持续时间、多囊卵巢综合征（与不明原因不孕相比）以及各自RCT中的随机干预组。
经调整分析，与未暴露人群（TSH <2.0 mU/L且TPO-Ab <30 U/mL，n = 865/1,578，54.8%）相比，暴露人群（TSH≥2.0 mU/L且TPO-Ab≥30 U/mL，n = 117/1,578，7.4%，调整风险比[ARR]：0.55；95%可信区间：0.35 - 0.87）的活产率显著降低。此外，与未暴露人群相比，暴露人群的妊娠丢失和早期早产（<32周）风险显著更高（妊娠丢失的ARR为1.66；95%可信区间：1.14 - 2.42，早期早产的ARR为4.82，95%可信区间：1.53 - 15.19）。
在TPO-Ab滴度≥30 U/mL的女性中，TSH阈值≥2 mU/L时妊娠结局可能受到影响。TSH和TPO对妊娠结局的这种相互作用的发现值得在前瞻性研究中进一步调查。
NCT00719186和NCT01044862。
