OBJECTIVE We examined if thyroid autoimmunity is relevant to the relationship between maternal TSH levels and pregnancy outcomes. DESIGN Retrospective cohort analysis of data from two randomized controlled trials (RCTs). SUBJECTS Participants of the Pregnancy in Polycystic Ovary Syndrome (PPCOS II, n = 746) and the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS, n = 832 with unexplained infertility) RCTs. EXPOSURE Pre-trial intervention levels of thyroid stimulating hormone (TSH) at threshold of ≥2.0 mU/L and thyroid peroxidase antibody (TPO-Ab) at titer threshold of ≥30 U/mL. MAIN OUTCOME Live birth (primary outcome), pregnancy loss and preterm birth (secondary outcomes). Generalized linear model (GLM) analyses examined the relationship between exposure to TSH and TPO-Ab at specified thresholds with the specified outcomes; covariates adjusted for included age, body mass index, race, ethnicity, education, smoking, duration of infertility, PCOS (versus unexplained infertility) and randomized intervention arm in the respective RCTs. RESULTS On adjusted analyses, live birth was significantly reduced in the exposed population (those with TSH ≥2.0 mU/L and TPO-Ab ≥30 U/mL, n= 117/1578, 7.4%, adjusted risk ratio [ARR] 0.55, 95% CI 0.35- 0.87) compared to the unexposed (those with TSH <2.0 mU/L and TPO-Ab <30 U/mL, n=865/1578, 54.8%). Furthermore, the risk of pregnancy loss and of early preterm birth (<32 weeks) was significantly higher in the exposed compared to the unexposed (ARR for pregnancy loss was 1.66, 95% CI 1.14- 2.42, and ARR for early preterm birth was 4. 82 (95% CI 1.53- 15.19). CONCLUSIONS In women with TPO-Ab titers ≥30 U/mL, pregnancy outcomes may be compromised at TSH threshold of ≥2 mU/L. These findings of an interaction between TSH and TPO for pregnancy outcomes merit further investigation in prospective studies.

中文翻译：

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重新审视 TSH 和甲状腺自身免疫与妊娠结局的相关性：来自 PPCOS II 和 AMIGOS 的 RCT 数据分析。


目的 我们检查了甲状腺自身免疫是否与母体 TSH 水平与妊娠结局之间的关系相关。设计 对来自两项随机对照试验 （RCT） 的数据进行回顾性队列分析。受试者 多囊卵巢综合征妊娠 （PPCOS II， n = 746） 和卵巢刺激宫内多胎妊娠评估 （AMIGOS， n = 832 不明原因不孕症） 随机对照试验的参与者。暴露 促甲状腺激素 （TSH） 的试验前干预水平为 ≥2.0 mU/L 阈值和甲状腺过氧化物酶抗体 （TPO-Ab） 的滴度阈值为 ≥30 U/mL。主要结局 活产 （主要结局）、流产和早产 （次要结局）。广义线性模型 （GLM） 分析检查了在特定阈值下暴露于 TSH 和 TPO-Ab 与特定结果之间的关系;在相应的 RCT 中，根据包括年龄、体重指数、种族、民族、教育程度、吸烟、不孕症持续时间、PCOS（与不明原因的不孕症相比）和随机干预组调整的协变量。结果在调整后的分析中，暴露人群（TSH ≥2.0 mU/L 和 TPO-Ab ≥30 U/mL，n= 117/1578,7.4%，调整后风险比 [ARR] 0.55，）的活产率显著降低。 95% CI 0.35-0.87） 与未暴露 （TSH <2.0 mU/L 和 TPO-Ab <30 U/mL，n=865/1578,54.8%） 相比。此外，与未暴露相比，暴露者的流产和早期早产风险（<32 周）显著更高（流产的 ARR 为 1.66,95% CI 1.14-2.42，早期早产的 ARR 为 4. 82 （95% CI 1.53-15.19）。结论 在 TPO-Ab 滴度 ≥30 U/mL 的女性中，TSH 阈值为 ≥2 mU/L 时妊娠结局可能受到影响。 TSH 和 TPO 之间对妊娠结局相互作用的这些发现值得在前瞻性研究中进一步调查。