Negro et al. the two guidelines, either one of two guidelines may be used by clinicians for the appropriate management of thyroid autoimmunity during pregnancy. 1. Introduction Thyroid disorders especially those of autoimmune origin are common in women of reproductive age. Normal maternal physiologic changes Elaidic acid during pregnancy lead to complex endocrine and immune modifications. Thyroid gland volume enlarges and serum levels of thyroxine (T4) and triiodothyronine increase, whereas serum TSH levels reduce [1, 2]. These modifications are related to TSH-like activity of HCG, rise in Elaidic acid thyroxin-binding globulin (TBG) due to hyperestrogenemia and resultant altered TBG glycosylation which increases TBG half life [3], elevated glomerular filtration rate (GFR), and transplacental passage of FT4. Ten to 20% of pregnant women are positive for thyroid peroxidase (TPO) or thyroglobulin antibodies and euthyroid, of whom 16% will develop high TSH values during pregnancy and 35C50% will develop postpartum thyroiditis. The prevalence Rabbit polyclonal to PELI1 of TPOAb is even higher in women with a history of recurrent pregnancy loss, at around 17C33%, and in women with a history of subfertility, at around 10C31% [4]. TPOAb constitutes a risk factor for hypothyroidism, miscarriage, preterm delivery, perinatal death, postpartum thyroid dysfunction and impaired motor, and intellectual development in the offspring. Miscarriage, or spontaneous pregnancy loss before the 24th week of gestation, is a common pregnancy complication affecting one in five pregnant women (17C33% of gestations) [5, 6]. Many factors like maternal age, family history, environmental exposure, and maternal medical conditions may be attributed to the risk of spontaneous pregnancy loss. Preterm birth, defined as Elaidic acid delivery before 32 weeks’ gestation, occurs in 6C15% of pregnancies and accounts for 75% of prenatal deaths, physical disabilities, and adverse neurodevelopmental outcomes [7]. Therefore, preterm delivery is accompanied by a high financial, psychological, and social burden on the parents and community [8]. Potential causes have been suggested for preterm labor, including trauma, infection, cervix insufficiency, premature rupture of membrane, and medical comorbidities. Elaidic acid The presence of thyroid autoantibodies is relatively high in women of childbearing age. There is evidence of the potential association of thyroid autoantibodies, particularly antithyroid peroxidase antibodies (TPOAb), and increased risk of pregnancy loss and preterm delivery even in euthyroid women [9]. The prevalence of TPOAb is much higher in women with a history of recurrent miscarriage and subfertility. In particular, in iodine-sufficient populations, thyroid autoimmunity is the main cause of hypothyroidism which itself contributes to adverse obstetric and fetal outcomes even in the subclinical state [9]. Although thyroglobulin autoantibodies (TgAb) are frequently detected along with TPOAb in autoimmune hypothyroidism, TgAb are also seen in some healthy individuals without detectable TPOAb. This occurrence of TgAb is uncorrelated with abnormal TSH levels, which indicates that it may not be necessary to test for TgAb and TPOAb in the general thyroid autoimmunity screening, as TPOAb testing alone seems sufficient [10]. In those individuals with indications of autoimmune thyroid disease (AITD), however, there is evidence that testing for both TPOAb and TgAb is beneficial [11, 12]. We only refer to TPOAb in this analysis. An association between the risk of a miscarriage and AITD has been largely confirmed in several population studies, suggesting that TPOAb presence without overt thyroid dysfunction was significantly associated with a 3- to 5-fold increase in overall miscarriage rate [9, 13C16]. The association between AITD and miscarriage, recurrent spontaneous abortions, and early pregnancy loss after 0.001) for the cohort studies and the odds ratio for miscarriage of 1 1.80 (95%??CI = 1.25 to 2.60; = 0.002) for case-control studies [24]. Other studies [26C29], mainly have been performed on pregnant women who underwent assisted reproduction technology (ART), yielded more contradictory and less clear results. Regarding on 984 TPOAb-positive Elaidic acid euthyroid pregnant women. They divided TPOAb euthyroid patients.