Longitudinal trajectories of gestational thyroid function

A new approach to better understand changes in thyroid function

Victor Pop*, Maarten Broeren, Hennie Wijnen, Joyce Endendijk, Anneloes van Baar, Wilmar Wiersinga, Graham R. Williams

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Context:  

Most studies of thyroid function changes during pregnancy use a cross-sectional design comparing means between groups rather than similarities within groups.

Objective:

Latent class growth analysis (LCGA) is a novel approach to investigate longitudinal changes that provide dynamic understanding of the relationship between thyroid status and advancing pregnancy.

Design: 

Prospective observational study with repeated assessments.

Setting: 

General community.

Patients: 

Eleven hundred healthy women were included at 12 weeks' gestation.

Main Outcome Measures: 

The existence of both free T4 (fT4) and TSH trajectories throughout pregnancy determined by LCGA.

Results: 

LCGA revealed three trajectory classes. Class 1 (n = 1019; 92.4%), a low increasing TSH reference group <had a gradual increase in TSH throughout gestation (from 1.1 to 1.3 IU/L). Class 2 (n = 30; 2.8%), a high increasing TSH grouP <displayed the largest increase in TSH (from 1.9 to 3.3 IU/L). Class 3 (n = 51; 4.6%), a decreasing TSH grouP <had the largest fall in TSH (from 3.2 to 2.4 IU/L). Subclinical hypothyroidism at 12 weeks occurred in up to 60% of class 3 women and was accompanied by elevated thyroid peroxidase antibodies (TPO-Ab) titers (50%) and a parental history of thyroid dysfunction (23%). In class 2, 70% of women were nulliparous compared with 46% in class 1 and 49% in class 3.

Conclusions:

LCGA revealed distinct trajectories of longitudinal changes in fT4 and TSH levels during pregnancy in 7.4% of women. These trajectories were correlated with parity and TPO-Ab status and followed patterns that might reflect differences in pregnancy-specific immune tolerance between nulliparous and multiparous women.

Original languageEnglish
Pages (from-to)2889-2900
JournalJournal of Clinical Endocrinology and Metabolism
Volume103
Issue number8
DOIs
Publication statusPublished - 2018

Keywords

  • REGULATORY T-CELLS
  • IRON-DEFICIENCY
  • EARLY-PREGNANCY
  • GENERATION-R
  • FETAL SEX
  • MANAGEMENT
  • DISEASE
  • GROWTH
  • ASSOCIATION
  • POSTPARTUM

Cite this

Pop, Victor ; Broeren, Maarten ; Wijnen, Hennie ; Endendijk, Joyce ; van Baar, Anneloes ; Wiersinga, Wilmar ; Williams, Graham R. / Longitudinal trajectories of gestational thyroid function : A new approach to better understand changes in thyroid function. In: Journal of Clinical Endocrinology and Metabolism. 2018 ; Vol. 103, No. 8. pp. 2889-2900.
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title = "Longitudinal trajectories of gestational thyroid function: A new approach to better understand changes in thyroid function",
abstract = "Context:  Most studies of thyroid function changes during pregnancy use a cross-sectional design comparing means between groups rather than similarities within groups.Objective:Latent class growth analysis (LCGA) is a novel approach to investigate longitudinal changes that provide dynamic understanding of the relationship between thyroid status and advancing pregnancy.Design: Prospective observational study with repeated assessments.Setting: General community.Patients: Eleven hundred healthy women were included at 12 weeks' gestation.Main Outcome Measures: The existence of both free T4 (fT4) and TSH trajectories throughout pregnancy determined by LCGA.Results: LCGA revealed three trajectory classes. Class 1 (n = 1019; 92.4{\%}), a low increasing TSH reference group Conclusions:LCGA revealed distinct trajectories of longitudinal changes in fT4 and TSH levels during pregnancy in 7.4{\%} of women. These trajectories were correlated with parity and TPO-Ab status and followed patterns that might reflect differences in pregnancy-specific immune tolerance between nulliparous and multiparous women.",
keywords = "REGULATORY T-CELLS, IRON-DEFICIENCY, EARLY-PREGNANCY, GENERATION-R, FETAL SEX, MANAGEMENT, DISEASE, GROWTH, ASSOCIATION, POSTPARTUM",
author = "Victor Pop and Maarten Broeren and Hennie Wijnen and Joyce Endendijk and {van Baar}, Anneloes and Wilmar Wiersinga and Williams, {Graham R.}",
year = "2018",
doi = "10.1210/jc.2017-02556",
language = "English",
volume = "103",
pages = "2889--2900",
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}

Longitudinal trajectories of gestational thyroid function : A new approach to better understand changes in thyroid function. / Pop, Victor; Broeren, Maarten; Wijnen, Hennie; Endendijk, Joyce; van Baar, Anneloes; Wiersinga, Wilmar; Williams, Graham R.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 103, No. 8, 2018, p. 2889-2900.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Longitudinal trajectories of gestational thyroid function

T2 - A new approach to better understand changes in thyroid function

AU - Pop, Victor

AU - Broeren, Maarten

AU - Wijnen, Hennie

AU - Endendijk, Joyce

AU - van Baar, Anneloes

AU - Wiersinga, Wilmar

AU - Williams, Graham R.

PY - 2018

Y1 - 2018

N2 - Context:  Most studies of thyroid function changes during pregnancy use a cross-sectional design comparing means between groups rather than similarities within groups.Objective:Latent class growth analysis (LCGA) is a novel approach to investigate longitudinal changes that provide dynamic understanding of the relationship between thyroid status and advancing pregnancy.Design: Prospective observational study with repeated assessments.Setting: General community.Patients: Eleven hundred healthy women were included at 12 weeks' gestation.Main Outcome Measures: The existence of both free T4 (fT4) and TSH trajectories throughout pregnancy determined by LCGA.Results: LCGA revealed three trajectory classes. Class 1 (n = 1019; 92.4%), a low increasing TSH reference group Conclusions:LCGA revealed distinct trajectories of longitudinal changes in fT4 and TSH levels during pregnancy in 7.4% of women. These trajectories were correlated with parity and TPO-Ab status and followed patterns that might reflect differences in pregnancy-specific immune tolerance between nulliparous and multiparous women.

AB - Context:  Most studies of thyroid function changes during pregnancy use a cross-sectional design comparing means between groups rather than similarities within groups.Objective:Latent class growth analysis (LCGA) is a novel approach to investigate longitudinal changes that provide dynamic understanding of the relationship between thyroid status and advancing pregnancy.Design: Prospective observational study with repeated assessments.Setting: General community.Patients: Eleven hundred healthy women were included at 12 weeks' gestation.Main Outcome Measures: The existence of both free T4 (fT4) and TSH trajectories throughout pregnancy determined by LCGA.Results: LCGA revealed three trajectory classes. Class 1 (n = 1019; 92.4%), a low increasing TSH reference group Conclusions:LCGA revealed distinct trajectories of longitudinal changes in fT4 and TSH levels during pregnancy in 7.4% of women. These trajectories were correlated with parity and TPO-Ab status and followed patterns that might reflect differences in pregnancy-specific immune tolerance between nulliparous and multiparous women.

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KW - IRON-DEFICIENCY

KW - EARLY-PREGNANCY

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KW - FETAL SEX

KW - MANAGEMENT

KW - DISEASE

KW - GROWTH

KW - ASSOCIATION

KW - POSTPARTUM

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JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

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