Background: Higher levels of thyroid autoantibodies in follicular fluid (FF) of thyroid autoimmunity (TAI) positive women are strongly correlated with serum levels and may have effect on the post-implantation embryo development. Literature highlights that levothyroxine (LT4) treatment may attenuate the risk of adverse pregnancy outcomes. The aim of the study was to estimate the pregnancy and newborn outcomes in women with FF thyroid autoantibodies undergoing assisted reproductive technology (ART).
Methods: The study population included 24 women with confirmed clinical pregnancy, 8 TAI positive and 16 TAI negative women. LT4 supplementation was applied in 20.8% patients, TAI positive.
Results: Pregnancy outcomes were: twin pregnancy rate 41.7%, early miscarriage rate 8.3%, late miscarriage rate 4.2%, preterm birth rate 16.7%, term birth rate 70.8%, live birth rate 96.0%. There was significant difference in serum and in FF TgAbs (p< 0.001)between the groups according to TAI, while serum fT3 was lower in the group with TAI (p = 0.047). Serum P4 was higher in LT4 treated group (p = 0.005), with TAI, and newborns in this group had higher birth weight (p = 0.001) and height (p = 0.008). Maternal complications occurred in 23.8% of patients. No congenital malformations in newborns were noted.
Conclusions: Thyroid autoantibodies present in FF may have an effect on the post-implantation embryo development, but have no effect on further course of pregnancy. The special benefit of LT4 treatment for successful ART outcome was demonstrated for newborn anthropometric parameters.
Uvod: Povišeni nivoi tiroidnih autoantitela u folikularnoj tečnosti (FF) kod žena sa tiroidnom autoimunošću (TAI) nalaze se u snažnoj korelaciji sa nivoima istih u serumu i mogu uticati na postimplantacioni razvoj embriona. Podaci iz literature govore o značaju primene levotiroksina (LT4) u smislu smanjenja rizika od neželjenih ishoda trudnoće. Cilj studije je bio da se proceni ishod trudnoće i karakteristike novorođenčeta žena sa tiroidnim autoantitelima u FF u postupku asistirane reprodukcije (A RT).
Metode: Ispitivana populacija je uključila 24 žene sa potvrđenom kliničkom trudnoćom, 8 TAI pozitivnih i 16 TAI negativnih žena. LT4 suplementacija je primenjena kod 20,8% pacijentkinja, pozitivnih na TAI.
Rezultati: Ishodi trudnoće bili su: stopa blizanačke trudnoće 4 1 ,7 % , stopa ranih sponatnih pobačaja 8,3% , stopa kasnih sponatnih pobačaja 4 ,2 % , stopa prevremenog porođaja 16,7% , stopa terminskog porođaja 70,8% , stopa živorođenosti 96,0% . Postojala je značajna razlika u vrednostima antitela na Tg u serumu i u FF (p < 0 ,0 0 1 ) između grupa shodno TAI, dok je serumski fT3 bio niži u grupi sa TAI (p = 0 ,0 4 7 ). Serumski fT 4 je bio viši u grupi koja je primala terapiju sa LT4 (p = 0 ,0 0 5 ), sa TAI, a novorođenčad u ovoj grupi imala su veću porođajnu težinu (p = 0,001) i dužinu (p = 0 ,0 0 8 ). Maternalne komplikacije bile su prisutne kod 23,8% pacijentkinja. Nisu zabeležene urođene malform acije kod novorođenčadi.
Zaključak: Tiroidna autoantitela u FF mogu da utiču na postimplantacioni razvoj embriona, ali nemaju uticaja na dalji tok trudnoće. Posebna korist terapije LT4 na uspešan ishod ART-a je pokazana za antropometrijske parametre novorođenčeta.
Keywords: assisted reproductive technology; follicular fluid; pregnancy; thyroid autoimmunity.
2023 Sanja Medenica, Eliana Garalejić, Džihan Abazović, Zoran Bukumirić, Stavroula A. Paschou, Biljana Arsić, Snežana Vujošević, Biljana Međo, Miloš Žarković, published by CEON/CEES.