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A meta-analysis of the effects of levothyroxine dose adjustment on maternal and infant outcomes in pregnant women with hypothyroidism
Received date: 2023-01-07
Accepted date: 2023-07-10
Online published: 2023-07-28
Objective ·To evaluate the effects of levothyroxine (L-T4) dose adjustment according to the level of thyroid stimulating hormone (TSH) on maternal and infant outcomes in the pregnant women with hypothyroidism by meta-analysis. Methods ·China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Data Knowledge Service Platform, PubMed, Cochrane Library and Embase were retrieved to collect all the controlled studies on the treatment of pregnant women with hypothyroidism by adjusting the dose of L-T4 according to TSH level from the establishment of the databases to April 9, 2022. The references were also traced. Literature screening, data extraction, and quality evaluation were performed independently by two researchers. Cochrane evaluation was used to evaluate the quality of the included literature. Outcome indicators included gestational hypertension, gestational diabetes, postpartum hemorrhage, delivery mode, preterm birth, fetal death, neonatal asphyxia, and low birth weight infants. RevMan 5.3 was used for meta-analysis. Result ·A total of 1 268 articles were retrieved from 6 databases, and 8 were included in the study, including 4 Chinese articles and 4 English articles. The overall risk of study bias was at a moderate level. Compared with the control group, the OR of gestational diabetes risk was 0.61 (95%CI 0.44?0.86, P=0.004) and the OR of fetal death risk was 0.38 (95%CI 0.18?0.81, P=0.010) in the experimental group with L-T4 dose adjusted according to the TSH level of the pregnant women with hypothyroidism, which were both statistically significant. However, the treatment method of adjusting L-T4 dose did not affect the risks of vaginal delivery [OR=1.82 (95%CI 0.75?4.40, P=0.180)], gestational hypertension [OR=0.77 (95%CI 0.53?1.12, P=0.170)], postpartum hemorrhage [OR=1.20 (95%CI 0.50?2.92, P=0.680)], preterm birth [OR=0.72 (95%CI 0.48?1.06, P=0.100)], low birth weight infants [OR=1.00 (95%CI 0.65?1.54, P=0.999)], or neonatal asphyxia [OR=0.50 (95%CI 0.20?1.27, P=0.150)] significantly. Conclusion ·Adjusting the L-T4 therapeutic dose according to the TSH level may help reduce the risks of gestational diabetes and fetal death in the pregnant women with hypothyroidism.
Hui CHEN , Weiyi ZHU , Yijin YAO . A meta-analysis of the effects of levothyroxine dose adjustment on maternal and infant outcomes in pregnant women with hypothyroidism[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023 , 43(7) : 906 -915 . DOI: 10.3969/j.issn.1674-8115.2023.07.013
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