To study the relationship between suboptimal maternal thyroid function during gestation and breech presentation at term.
Design
Prospective follow-up study during three trimesters of gestation.
Patients
A total of 1058 Dutch Caucasian healthy pregnant women were prospectively followed from 12 weeks gestation until term (>or=37 weeks) delivery.
MEASUREMENTS: Maternal thyroid parameters [TSH, free T4 (FT4) and auto-antibodies to thyroid peroxidase] were assessed at 12, 24 and 36 weeks gestation as well as foetal presentation at term.
Results
At term, 58 women (5.5%) presented in breech. Compared with women with foetuses in the cephalic position, those women who presented in breech at term had significantly higher TSH concentrations, but only at 36 weeks gestation (P = 0.007). No between group differences were obtained for FT4 level at any assessment. The prevalence of breech presentation in the subgroup of women with TSH >or= 2.5 mIU/l (90th percentile) at 36 weeks gestation was 11%, compared with 4.8% in the women with TSH < 2.50 mIU/l (P = 0.006). Women with TSH below the 5th percentile had no breech presentations. Breech position was significantly and independently related to high maternal TSH concentration (>or=2.5 mIU/l) at 36 weeks gestation (O.R.: 2.23, 95% CI: 1.14-4.39), but not at 12 and 24 weeks gestation.
Conclusions
Women with TSH levels above 2.5 mIU/l during end gestation are at risk for breech presentation, and as such for obstetric complications.
PMID 19832853 19832853 DOI 10.1111/j.1365-2265.2009.03729.x 10.1111/j.1365-2265.2009.03729.x
Cite this article
Kuppens, S. M. I., Kooistra, L., Wijnen, H. A., Crawford, S., Vader, H. L., Hasaart, T. H., Oei, S. G., & Pop, V. J. (2010). Maternal thyroid function during gestation is related to breech presentation at term. Clinical endocrinology, 72(6), 820-824. https://doi.org/10.1111/j.1365-2265.2009.03729.x
Kuppens SMI, Kooistra L, Wijnen HA, Crawford S, Vader HL, Hasaart TH, et al. Maternal thyroid function during gestation is related to breech presentation at term. Clin Endocrinol (Oxf). 2010;72(6):820-824. doi:10.1111/j.1365-2265.2009.03729.x
Kuppens, Simone M. I., et al. "Maternal thyroid function during gestation is related to breech presentation at term." Clinical endocrinology, vol. 72, no. 6, 2010, pp. 820-824.
Keywords
Adult, Breech Presentation/epidemiology/etiology, Female, Humans, Longitudinal Studies, Mothers, Pregnancy/physiology, Pregnancy Complications/blood/epidemiology, Term Birth/physiology, Thyroid Diseases/blood/complications/epidemiology, Thyroid Function Tests, Thyroid Gland/physiology, Thyroid Hormones/blood, Thyrotropin/blood, Young Adult, Thyroid Hormones, Thyrotropin
Vissenberg R et al., 2016·Eur J Obstet Gynecol Reprod Biol
Thyroid dysfunction has been described as a possible risk factor for having an abnormal fetal position at birth. In this study we aim to determine the association between thyroid function in early pregnancy and breech presentation at term. We used data from the Amsterdam Born Children and their Development (ABCD) cohort. 3347 pregnant women were included between January 2003 and March 2004 in Amsterdam, the Netherlands. Thyroid function tests were performed between 5 and 37 weeks gestational age (median 12.9 weeks). The main outcome measure was the association between thyroid function in early pregnancy and breech presentation at term. Univariate and multivariate analysis were performed to determine the association between thyroid function and breech presentation. Increased TSH in pregnancy, defined as thyroid stimulating hormone (TSH) >97.5th percentile (>3.53mIU/L), was associated with a higher risk for breech presentation at term (aOR 2.32, CI 1.1-4.8, p=0.02) compared to euthyroidism (TSH between 2.5th and 97.5th percentile). After exclusion of overt hypothyroidism and hyperthyroidism the aOR was 2.34 (CI 1.1-5.0, p=0.03). Trimester specific analysis showed a significant association of increased TSH levels (>3.68mIU/L) in the second trimester with breech presentation (aOR 3.7, CI 1.7-7.8, p=0.001). In the second trimester low free thyroxine (FT4) <2.5th percentile (<6.7pmol/L) was also associated with breech presentation (aOR 2.5, CI 1.0-6.3, p=0.04). Increased TSH and decreased FT4 in the second trimester of pregnancy are associated with an increased risk for breech presentation at term. The association of abnormal thyroid parameters in the first of third trimester is still unclear.
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Bone HealthAdolescent Peak BMD AccrualBone Health EffectsProspective Controlled Studies
Open Access
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