Thyroid Stimulating Hormone (TSH) Level Variations in Early Pregnancy
Thyroid Stimulating Hormone (TSH) Level Variations in Early Pregnancy
Retrospective comparative study comparing group 1 (TSH level 0.1-1.99 mIU/L) and group 2 (TSH
 level 2.0-4 mIU/L). Each group was further subdivided into primigravidae and multipara. 1527
 pregnant women were included.
This was a retrospective comparative study spanning January 2014 to December 2018. It was
 conducted at Jordan university hospital, a teaching referral hospital affiliated to the
 University of Jordan, Amman, Jordan. Pregnant patients, both primigravida and multipara who
 had a spontaneous singleton pregnancy with documented TSH level in the first 16 weeks'
 gestation were included. The investigators excluded all patients who had known thyroid
 dysfunction whether on treatment or not, molar pregnancies, multiple pregnancies, patients
 with hyperemesis gravidarum, all patients with anti-thyroid antibodies (Anti-TPO), patients
 with TSH ˃ 4.0 mIU/L or ˂ 0.1 mIU/L. This range was used as TSH ˂ 0.1 mIU/L indicated an
 undiagnosed subclinical hyperthyroidism and TSH ˃4.0 indicated undiagnosed hypothyroidism. In
 addition, there were wide variations in the TSH reference ranges. Participants' data were
 collected retrospectively from antenatal clinic notes, admission notes, labor ward and
 operative notes. Data included patients ID number, age, parity, body mass index (BMI) in
 kg/m2, TSH values in the first 16 weeks of pregnancy. The participants were divided into 2
 groups according to their TSH values. Group one with TSH values between 0.1-1.99 mIU/L. Group
 2 had TSH values between 2-4 mIU/L. Each group was then subdivided into 2 subgroups;
 primigravida and multipara. Group P1: Primigravida in group 1, Group P2: Primigravida in
 group 2, Group M1: Multiparous in group 1, Group M2: Multiparous in group 2.

 The investigators calculated the mean, median and range of TSH in each subgroup. The
 feto-maternal outcome was then compared between the 2 groups. The investigators studied
 miscarriage rate, ectopic pregnancy rate, maternal blood sugar values (Fasting blood sugar
 (FBS), glucose tolerance test (GTT), HbA1c or a combination) between 26 and 34 weeks,
 development of high blood pressure at delivery, duration of pregnancy (gestational age at
 delivery), preterm delivery rate, abruption placenta, mode of delivery, birth weight and
 APGAR score at 1 and 5 minutes. Gestational diabetes mellitus (GDM) was diagnosed as an FBS
 92-125 mg/dL or 1-hour plasma glucose levels of 180 or more following 75-gram oral glucose
 load or 2-hour plasma glucose 153-199 mg/dL. The study obtained the approval of the
 institutional review board (IRB) at Jordan University Hospital (JUH) number 179/2019 dated
 17/4/2019.

 The statistical analysis was performed with the Data Toolkit in Excel (Microsoft, Redmond,
 WA, USA) using descriptive analysis. Relative risk and 95% confidence intervals were also
 calculated to compare variables. P values were considered significant at ˂0.05. The obtained
 data were examined using a frequency table and are presented as frequency, percentage and
 mean
Inclusion Criteria:

 1. Pregnant women

 2. Previously healthy

 Exclusion Criteria:

 1. known thyroid diseases