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New Research Indicates Higher Risk For Miscarriage In Pregnant Women With Thyroid Hormone
Levels On High End Of Normal (Medical News Today:25 June 2010)

Pregnant women with thyroid function test results in the upper half of the normal range have an increased
chance of miscarriage, even when they lack thyroid-harming antibodies, according to a new study. The
results, which the authors say show the need to change screening practices for pregnant women, will be
presented at The Endocrine Society's 92nd Annual Meeting, ENDO 2010, in San Diego on June 22 by
Alex Stagnaro-Green, M.D., senior author and senior associate dean for education at The George
Washington University School of Medicine and Health Sciences.

Past studies have reported an increased miscarriage rate in women with an underactive thyroid and in
women with a positive thyroid peroxidase antibody test, indicating the presence of antibodies directed
against the thyroid.

"This study is the first evidence demonstrating that the upper half of the accepted normal range on thyroid
function tests is associated with miscarriage in antibody-negative women. This leads us to think that all
pregnant women should be screened for thyroid function and any abnormalities treated," said Dr.
Stagnaro-Green.

Thyroid function is measured by the thyroid stimulating hormone (TSH) blood test, and anything above
the upper limit is an underactive thyroid, called hypothyroidism. Since 2007, the recommended upper
limit of the normal range of the TSH test for a pregnant woman has been 2.5 milli-international units per
liter (mIU/L) in the first trimester and 3 mIU/L in the second and third trimesters. This recommendation
was made by an Endocrine Society international guideline committee, of which Dr. Stagnaro-Green was a
member. However, he said doctors have not universally accepted this guideline, and some use 4.5 or 5
mIU/L for an upper limit, the same as for nonpregnant women. Also, not every pregnant woman receives
thyroid function screening.

To see if TSH on the high end of normal affects pregnancy outcomes, the researchers determined the
pregnancy loss and preterm delivery rates of women who had TSH values between 2.5 and 5 mIU/L in
their first trimester of pregnancy. They conducted the study at two community hospitals in Italy among
pregnant outpatients who had a TSH level at or below 5 mIU/L during their first semester. After
excluding patients who had positive thyroid antibody tests, the investigators studied 4,123 women. They
divided subjects into two groups based on TSH level (mIU/L): group A: below 2.5, excluding those who
had an overactive thyroid, and group B: between 2.5 and 5.

There was no difference in the rate of preterm delivery between the two groups. However, the rate of
miscarriage was significantly higher in group B (higher normal TSH) than group A (lower normal TSH):
6.1 percent versus 3.6 percent, respectively.

None of the antibody-negative women in the current study received thyroid hormone treatment. However,
Dr. Stagnaro-Green said previous research shows that such treatment lowers the miscarriage rate in
antibody-positive women.