Hypothyroidism in Pregnancy and Birth

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Expectant mothers who are experiencing the symptoms of hypothyroidism should get tested immediately.

It is not an uncommon sight to see soon-to-be mothers and doting dads doing everything they can to prepare for the arrival of their precious little one. From attending antenatal classes together, to shopping for essential baby care items and even choosing the perfect colour for the nursery room, they’ve got it all covered. After all, parents desire the best start for their children.

However, despite our best efforts, things may not go as planned during pregnancy because some things may be beyond our control such as the tremendous changes a woman’s body undergoes to accommodate a growing and developing child within her. This includes an often overlooked butterfly-shaped organ at the base of the neck, the thyroid gland. 1

According to Professor Dr Nor Azmi Kamaruddin, Chairman of Transform Your Life hypothyroidism awareness programme, a healthy, well-functioning thyroid gland is important to everyone, but it is especially important to women in their childbearing years.2

The consultant endocrinologist explained: “When a woman is pregnant, her body needs enough thyroid hormones to support her own increased metabolic needs as well as her unborn baby. A healthy thyroid gland is able to naturally meet the increased demand for thyroid hormones by her baby.3

“However, the thyroid gland of some women may be unable to cope with the increased demand resulting in maternal hypothyroidism – a thyroid disorder where insufficient thyroid hormones are produced”.3 This can cause serious consequences to both the mother and child, and even endangering their health. 4

Pregnancy and birth complications

When there is an inadequate supply of thyroid hormones in the blood, various bodily functions may be affected resulting in symptoms such as fatigue, inappropriate weight gain, constipation and increased sensitivity to cold among others. 1

However, expectant mothers are often all too familiar with these symptoms and may write them off as normal features of pregnancy. 3 Some women may even have mild (subclinical) hypothyroidism where symptoms are either mild or absent. 1 These could lead to the disorder remaining undiagnosed and therefore untreated.

If this condition persists, it may lead to pregnancy-induced hypertension, stillbirth, preterm delivery and placental abruption. 5 These complications could threaten your life and your baby’s.

After giving birth

Some women with normal-functioning thyroid glands may develop postpartum thyroiditis (PPT), an inflammation of the thyroid gland, within the first year of giving birth. Although the exact cause of PPT isn’t clear, it is likely that women with this condition have an underlying autoimmune thyroid condition that flares after childbirth due to fluctuations in immune function.6

Sadly, PPT can be difficult to recognise as it is often masked by the stress of caring for a newborn and also postpartum mood disorders which may cause much discomfort and emotional ups and downs in the mother.6 Additionally, these women have a higher risk of developing permanent hypothyroidism in the following 5-10 years following the episode of PPT. 7

Know your thyroid status

Prof Nor Azmi emphasised that maternal hypothyroidism is the most common thyroid disorder during pregnancy. 5 However, he pointed out that women are often unaware of the disorder. Hence, they go about their daily lives with the disorder unchecked and untreated.

He advised: “It only takes a simple blood test at any clinic or hospital to reveal if you have the disorder.4 You could be at risk if you have a family history of thyroid disorders, personal history of miscarriage or preterm delivery or Type 1 diabetes or other autoimmune diseases.5

“You may be provided with thyroxine pills, a synthetic form of your thyroid hormones to help manage hypothyroidism. These pills are necessary for the well-being of your unborn baby.4

“Lastly, let’s take note that hypothyroidism can have profound effects on your child’s growth and development. When left untreated, hypothyroidism may lead to impaired brain development, especially during the first trimester. This is a great tragedy considering that the disorder can be easily treated thus preventing such an outcome”. 1

Prof Nor Azmi stressed: “We must take hypothyroidism seriously, for the sake of expectant mothers and their child. Mothers must be empowered to check for hypothyroidism as it is important for them to understand the role of the thyroid in maintaining a healthy pregnancy and thus baby”.

He encouraged mothers to visit www.tyl.my to learn more about hypothyroidism during pregnancy and what they can do about it.

 Article contributed by Malaysian Endocrine and Metabolic Society under the Transform Your Life programme, supported by Merck Biopharma.

Reference

  1. Sahay RK, Nagesh VS. Hypothyroidism in pregnancy. Indian J Endocrinol Metab. 2012 May-Jun;16(3): 364–370.
  2. Thyroid Australia. Postpartum Thyroiditis [Internet]. 2001 [cited 2016 Apr 28]. Available from: http://www.thyroid.org.au/ThySoc/ThySocPPTD.html
  3. AACE Thyroid Awareness. The Thyroid and Pregnancy [Internet]. n.d. [cited 2016 Apr 28]. Available from: http://www.thyroidawareness.com/the-thyroid-and-pregnancy#top
  4. National Institute of Diabetes and Digestive and Kidney Diseases. Pregnancy and Thyroid Disease [Internet]. 2013 [cited 2016 Apr 28]. Available from: http://www.niddk.nih.gov/health-information/health-topics/endocrine/pregnancy-and-thyroid-disease/Pages/fact-sheet.aspx#sup2
  5. Thyroid Screening in Pregnant Women. Putrajaya: Medical Development Division, Ministry of Health Malaysia. 2008 December.
  6. Mayo Clinic. Postpartum thyroiditis [Internet]. 2013 [cited 2016 May 17]. Available from: http://www.mayoclinic.org/diseasesconditions/postpartumthyroiditis/basics/causes/con20035474
  7. Abalovich M, Amino N, Barbour LA, Cobin RH, De Groot LJ, Glinoer D, Mandel SJ, and Stagnaro-Green A. Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism. 2007. 92(8) (Supplement):S1–S47

 

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