Maternal hypothyroidism and hyperthyroidism are risk factors for preterm birth. Milder thyroid function test abnormalities and thyroid autoimmunity are more prevalent, but it remains controversial if these are associated with preterm birth.To study if maternal thyroid function test abnormalities and thyroid autoimmunity are risk factors for preterm birth.Studies were identified through a search of the Ovid MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, and Google Scholar databases from inception to March 18, 2018, and by publishing open invitations in relevant journals. Data sets from published and unpublished prospective cohort studies with data on thyroid function tests (thyrotropin [often referred to as thyroid-stimulating hormone or TSH] and free thyroxine [FT4] concentrations) or thyroid peroxidase (TPO) antibody measurements and gestational age at birth were screened for eligibility by 2 independent reviewers. Studies in which participants received treatment based on abnormal thyroid function tests were excluded.The primary authors provided individual participant data that were analyzed using mixed-effects models.The primary outcome was preterm birth (<37 weeks' gestational age).From 2526 published reports, 35 cohorts were invited to participate. After the addition of 5 unpublished data sets, a total of 19 cohorts were included. The study population included 47 045 pregnant women (mean age, 29 years; median gestational age at blood sampling, 12.9 weeks), of whom 1234 (3.1%) had subclinical hypothyroidism (increased thyrotropin concentration with normal FT4 concentration), 904 (2.2%) had isolated hypothyroxinemia (decreased FT4 concentration with normal thyrotropin concentration), and 3043 (7.5%) were TPO antibody positive; 2357 (5.0%) had a preterm birth. The risk of preterm birth was higher for women with subclinical hypothyroidism than euthyroid women (6.1% vs 5.0%, respectively; absolute risk difference, 1.4% [95% CI, 0%-3.2%]; odds ratio [OR], 1.29 [95% CI, 1.01-1.64]). Among women with isolated hypothyroxinemia, the risk of preterm birth was 7.1% vs 5.0% in euthyroid women (absolute risk difference, 2.3% [95% CI, 0.6%-4.5%]; OR, 1.46 [95% CI, 1.12-1.90]). In continuous analyses, each 1-SD higher maternal thyrotropin concentration was associated with a higher risk of preterm birth (absolute risk difference, 0.2% [95% CI, 0%-0.4%] per 1 SD; OR, 1.04 [95% CI, 1.00-1.09] per 1 SD). Thyroid peroxidase antibody-positive women had a higher risk of preterm birth vs TPO antibody-negative women (6.6% vs 4.9%, respectively; absolute risk difference, 1.6% [95% CI, 0.7%-2.8%]; OR, 1.33 [95% CI, 1.15-1.56]).Among pregnant women without overt thyroid disease, subclinical hypothyroidism, isolated hypothyroxinemia, and TPO antibody positivity were significantly associated with higher risk of preterm birth. These results provide insights toward optimizing clinical decision-making strategies that should consider the potential harms and benefits of screening programs and levothyroxine treatment during pregnancy.

Adequate thyroid hormone availability is important for an uncomplicated pregnancy and optimal fetal growth and development. Overt thyroid disease is associated with a wide range of adverse obstetric and child development outcomes. An increasing number of studies now indicate that milder forms of thyroid dysfunction are also associated with these adverse pregnancy outcomes. The definitions of both overt and subclinical thyroid dysfunction have changed considerably over the past few years, as new data indicate that the commonly used fixed upper limits of 2.5 mU/l or 3.0 mU/l for thyroid-stimulating hormone (TSH) are too low to define an abnormal thyroid function. Furthermore, some studies now show that the reference ranges are not necessarily the best cut-off for identifying pregnancies at high risk of adverse outcomes. In addition, data suggest that thyroid peroxidase autoantibody positivity and high or low concentrations of human chorionic gonadotropin seem to have a more prominent role in the interpretation of thyroid dysfunction than previously thought. Data on the effects of thyroid disease treatment are lacking, but some studies indicate that clinicians should be aware of the potential for overtreatment with levothyroxine. Here, we put studies from the past decade on reference ranges for TSH, determinants of thyroid dysfunction, risks of adverse outcomes and options for treatment into perspective. In addition, we provide an overview of the current views on thyroid physiology during pregnancy and discuss strategies to identify high-risk individuals who might benefit from levothyroxine treatment.

To compare the inflammatory markers between therapeutic and emergency cerclage and assess the predictive role of inflammatory markers for the latency period.Descriptive study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Bursa Yuksek Ihtisas Training and Research Hospital, Turkiye, from January 2016 to September 2022.The therapeutic cerclage group (n = 64) included patients with a history of cervical insufficiency, normal prenatal screening test results, and who underwent cerclage based on history indications. The emergency cerclage group (n = 14) included patients with painless cervical dilation in the second trimester or a history of preterm and a short cervix on ultrasonography. Exclusion criteria composed of multiple pregnancies, active uterine contractions, vaginal bleeding, chorioamnionitis, membrane rupture, foetal anomalies, history of conization or abdominal cerclage, and having inflammatory diseases. Sociodemographic features, perinatal outcomes, and inflammatory markers such as neutrophil-to-lymphocyte ratio, C-reactive protein, and systemic immune-inflammation index were compared. Systemic immune-inflammation index was calculated by formulating the multiplication value of the neutrophil and platelet count divided by the lymphocyte count.The latency period was shorter (5.5 (0-29) vs. 20 (1-31) weeks, p <0.001) in the emergency cerclage group. Neutrophil-to- lymphocyte ratio and systemic immune-inflammation index, which are representatives of increased inflammatory state, were significantly higher in the emergency cerclage group (p = 0.007 for both). Systemic immune-inflammation index was correlated with cerclage to delivery interval for all patients (r = -0.307, p = 0.006). Also, it predicted neonatal mortality with a cut-off value of 1078.08, 90% sensitivity and 70.59% specificity (AUC = 0.776, p <0.001) and low Apgar scores with 57.1% sensitivity and 74% specificity (AUC = 0.641, p = 0.038).Systemic immune-inflammation index, correlated with cerclage to delivery interval, could be a marker for predicting neonatal mortality and morbidity in cerclage patients.Cervical cerclage, Inflammatory markers, Perinatal outcomes, Systemic immune-inflammation index.

Preterm birth is a leading cause of infant mortality, morbidity, and long-term disability, and these risks increase with decreasing gestational age. Obesity increases the risk of preterm delivery, but the associations between overweight and obesity and subtypes of preterm delivery are not clear.To study the associations between early pregnancy body mass index (BMI) and risk of preterm delivery by gestational age and by precursors of preterm delivery.Population-based cohort study of women with live singleton births in Sweden from 1992 through 2010. Maternal and pregnancy characteristics were obtained from the nationwide Swedish Medical Birth Register.Risks of preterm deliveries (extremely, 22-27 weeks; very, 28-31 weeks; and moderately, 32-36 weeks). These outcomes were further characterized as spontaneous (related to preterm contractions or preterm premature rupture of membranes) and medically indicated preterm delivery (cesarean delivery before onset of labor or induced onset of labor). Risk estimates were adjusted for maternal age, parity, smoking, education, height, mother's country of birth, and year of delivery.Among 1,599,551 deliveries with information on early pregnancy BMI, 3082 were extremely preterm, 6893 were very preterm, and 67,059 were moderately preterm. Risks of extremely, very, and moderately preterm deliveries increased with BMI and the overweight and obesity-related risks were highest for extremely preterm delivery. Among normal-weight women (BMI 18.5-<25), the rate of extremely preterm delivery was 0.17%. As compared with normal-weight women, rates (%) and adjusted odds ratios (ORs [95% CIs]) of extremely preterm delivery were as follows: BMI 25 to less than 30 (0.21%; OR, 1.26; 95% CI, 1.15-1.37), BMI 30 to less than 35 (0.27%; OR, 1.58; 95% CI, 1.39-1.79), BMI 35 to less than 40 (0.35%; OR, 2.01; 95% CI, 1.66-2.45), and BMI of 40 or greater (0.52%; OR, 2.99; 95% CI, 2.28-3.92). Risk of spontaneous extremely preterm delivery increased with BMI among obese women (BMI≥30). Risks of medically indicated preterm deliveries increased with BMI among overweight and obese women.In Sweden, maternal overweight and obesity during pregnancy were associated with increased risks of preterm delivery, especially extremely preterm delivery. These associations should be assessed in other populations.

The aim of this study was to assess the risk of adverse perinatal outcomes in gestational diabetes mellitus (GDM) in a large national cohort.All deliveries taking place after 22 weeks in France in 2012 were included by extracting data from the hospital discharge database and the national health insurance system. The diabetic status of mothers was determined by the use of glucose-lowering agents and by hospital diagnosis. Outcomes were analysed according to the type of diabetes and, in the GDM group, whether or not diabetes was insulin-treated.The cohort of 796,346 deliveries involved 57,629 (7.24%) mothers with GDM. Mother-infant linkage was obtained for 705,198 deliveries. The risks of adverse outcomes were much lower with GDM than with pregestational diabetes. After limiting the analysis to deliveries after 28 weeks to reduce immortal time bias, the risks of preterm birth (OR 1.3 [95% CI 1.3, 1.4]), Caesarean section (OR 1.4 [95% CI 1.4, 1.4]), pre-eclampsia/eclampsia (OR 1.7 [95% CI 1.6, 1.7]), macrosomia (OR 1.8 [95% CI 1.7, 1.8]), respiratory distress (OR 1.1 [95% CI 1.0, 1.3]), birth trauma (OR 1.3 [95% CI 1.1, 1.5]) and cardiac malformations (OR 1.3 [95% CI 1.1, 1.4]) were increased in women with GDM compared with the non-diabetic population. Higher risks were observed in women with insulin-treated GDM than those with diet-treated GDM. After limiting the analysis to term deliveries, an increased risk of perinatal mortality was observed. After excluding women suspected to have undiagnosed pregestational diabetes, the risk remained moderately increased only for those with diet-treated GDM (OR 1.3 [95% CI 1.0, 1.6]).GDM is associated with a moderately increased risk of adverse perinatal outcomes, which is higher in insulin-treated GDM than in non-insulin-treated GDM for most outcomes.

Cervical insufficiency poses significant risks to ongoing pregnancies, often necessitating interventions such as cervical cerclage. This review compares pregnancy outcomes in women who underwent emergency or elective cerclage. A comprehensive literature search of PubMed, Scopus, Embase, Cochrane library and Web of Science databases was conducted from the inception of these databases up to 30 April 2024. The risk of bias was assessed using the Newcastle Ottawa scale (NOS). Odds ratios (OR) and weighted mean differences (WMD) were calculated depending on the type of outcome using random-effects model. Overall, 27 studies were included. Gestational age of women who underwent emergency cerclage was significantly higher at cerclage (WMD of 6.500 and 5.698 weeks for physical examination-guided and ultrasound-guided cerclage, respectively, compared to elective cerclage). Emergency cerclage placement was associated with lower neonatal birth weights, particularly in the physical examination-guided group (WMD = -780.52 grams). The risk of PROM was higher in the physical examination-guided emergency cerclage group (OR = 2.197). However, the incidence of PROM was comparable in the elective and ultrasound-guided groups. Physical examination-guided cerclage was associated with significantly higher vaginal delivery rates compared to the emergency cerclage (OR = 1.750). Emergency cerclage, especially when guided by physical examination, is associated with later gestation at application and higher risks of adverse neonatal outcomes compared to elective cerclage.PROSPERO: CRD42024546566.Copyright: © Pakistan Journal of Medical Sciences.