Endocrine Abstracts (2006) 11 P837

The role of autoimmunity and thyroid function on pregnancy outcomes in euthyroid women with autoimmune disease undergoing assisted reproduction

R Negro1, G Formoso1, L Coppola2, G Presicce2, T Mangieri2, A Pezzarossa3 & D Dazzi3

1Dept. of Endocrinology, Lecce, Italy; 2Dept. of Physiopathology of Human Reproduction, Brindisi, Italy; 3Dept. of Internal Medicine, Fidenza, Italy.

Context: Euthyroid women positive for thyroid antibodies are prone to develop subclinical/overt hypothyroidism during gestation and seem to suffer from a poor outcome.

Objective: Assessing if patients with autoimmune thyroid disease undergoing Assisted Reproduction Technologies (ART) are afflicted by poor pregnancy and/or delivery rate and if the outcome is conditioned by pre-ART thyroid status.

Design: Prospective study since January 1999 until June 2006. Women undergoing ART were screened for TSH, FT4, TPOAb.

Setting: Division of Physiopathology of Human Reproduction.

Patients: A total of 464 euthyroid women were selected; 52 (11.2%) were TPOAb (+).

Main outcomes: The endpoints were pregnancy rate, miscarriage rate and obstetrical complications.

Results: No difference in pregnancy rate was observed between women with and without antibodies. The rates of miscarriage and pre-term delivery were higher in TPOAb (+) than TPOAb (−) [P=0.049; RR=1.1 (95% CI=0.98–1.25); P=0.023; RR=1.2 (95% CI=0.98–1.4), respectively]. In TPOAb (+), women who miscarried displayed higher TSH values before ART (2.8 mIU/L) compared to the ones who delivered or failed to become pregnant (1.6 and 1.7 mIU/L; P=0.032 and P=0.018 respectively).

Conclusions: In euthyroid women undergoing ART the pregnancy rate is not affected either by the presence of TPOAb or thyroid function. TPOAb (+) showed significantly increased number of miscarriages and pre-term deliveries; thyroid function before ART appears to play a pivotal role in determining the gestation outcome. These results show that thyroid autoimmunity and even a mild thyroid impairment represent risk factors for obstetrical complications (miscarriage and pre-term delivery). Further studies are required to ascertain possible benefits of levothyroxine in such patients.

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