Vissenberg, R., Fliers, E., van der Post, J. A., van Wely, M., Bisschop, P. H., & Goddijn, M. (2016). Live-birth rate in euthyroid women with recurrent miscarriage and thyroid peroxidase antibodies. Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology, 32(2), 132-135. https://doi.org/10.3109/09513590.2015.1092513
Vissenberg R, Fliers E, van der Post JA, van Wely M, Bisschop PH, Goddijn M. Live-birth rate in euthyroid women with recurrent miscarriage and thyroid peroxidase antibodies. Gynecol Endocrinol. 2016;32(2):132-135. doi:10.3109/09513590.2015.1092513
Vissenberg, Rosa, et al. "Live-birth rate in euthyroid women with recurrent miscarriage and thyroid peroxidase antibodies." Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology, vol. 32, no. 2, 2016, pp. 132-135.
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Academic Medical Centre, Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands. Electronic address: r.vissenberg@amc.uva.nl.03t4gr691
Academic Medical Centre, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands.
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RRM Academy Synopsis
Untreated thyroid antibodies and fewer births in recurrent miscarriage
Women with thyroid antibodies who took no levothyroxine had a lower live-birth rate. The study looked back at 202 Amsterdam women who kept miscarrying for no known reason and had normal thyroid function. In the untreated antibody group, about 3 out of 10 had a baby within 12 months. Among women without antibodies, about 5 out of 10 did.
About 3 in 10 women with thyroid antibodies and no levothyroxine had a live birth at 12 months. Source: Vissenberg R et al., 2016, PMID 26430806.Study at a glance, retrospective cohort of 202 women: Untreated thyroid antibodies went with fewer live births. Source: Vissenberg R et al., 2016, PMID 26430806.
Key Findings
Of 202 participating women, 28 had thyroid peroxidase antibodies (13.9%) and 174 did not (86.1%).
At 12 months, live birth occurred in 29% of women with antibodies and no levothyroxine, against 51% of women without (adjusted HR 0.23, CI 0.07–0.72, p = 0.012).
With levothyroxine, the 12-month live-birth rate in women with antibodies was 60%, against 51% in women without antibodies (adjusted HR 1.28, CI 0.62–2.63).
The 12-month pregnancy rate was 44% in women with antibodies and no levothyroxine, against 69% in women without antibodies (adjusted HR 0.47, 95% CI 0.24–0.95, p = 0.032).
With levothyroxine, the 12-month pregnancy rate was 67% in women with antibodies, against 69% in women without antibodies (adjusted HR 0.86, 95% CI 0.40–1.84, p = 0.695).
Interpretation
This retrospective cohort study followed 202 Amsterdam women. All had unexplained recurrent miscarriage and normal thyroid function. Women with thyroid antibodies who took no levothyroxine had lower rates of pregnancy and live birth. Women with antibodies who took levothyroxine had rates close to women with no antibodies. The findings support larger randomized trials of levothyroxine in this group.
RRM Context
Restorative reproductive medicine treats recurrent miscarriage as undiagnosed and looks for a cause before treating. This group of women had lower birth and pregnancy rates when they had thyroid antibodies and got no treatment.
Our editorial summary of this paper, not the article's abstract.
Abstract
Thyroid autoimmunity with normal thyroid function is associated with recurrent miscarriage (RM), but the association with live birth is less clear. Therefore, we determined the association between thyroid peroxidase antibodies (TPO-Ab) and live-birth rate (LBR) in a retrospective cohort of euthyroid women with unexplained RM. We included 202 women of which 28 were TPO-Ab positive (13.9%) and 174 were TPO-Ab negative. TPO-Ab positive women (n = 10) without levothyroxine treatment had a lower LBR (29%) compared to TPO-Ab negative women (51%) (HR 0.23, 0.07-0.72, p = 0.012). The LBR in women with TPO-Ab receiving levothyroxine was not different compared women without TPO-Ab (60% versus 51%, p = 0.50). In conclusion, TPO-Ab are associated with a lower LBR in euthyroid women with unexplained RM and these women may benefit from treatment with levothyroxine.
Miscarriage affects approximately 15% of clinically confirmed pregnancies. Recurrent pregnancy loss (RPL), defined as two or more clinical losses, affects 2 to 5% of couples. Most causes are diagnosable and treatable. This guide covers what the standard workup misses, what RRM-trained clinicians evaluate, and what outcomes look like after cause-based treatment.
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