High thyrotrophin levels at end term increase the risk of breech presentation.

Abstract:

OBJECTIVE:To study the relationship between maternal thyrotrophin (TSH) and breech presentation at term. DESIGN:Combined data sets of two prospective studies to obtain adequate epidemiological power. PATIENTS:One thousand and fifty-eight healthy pregnant women (58 breech, 1000 cephalic) and 131 women who presented in breech at an obstetrical outpatient clinic. MEASUREMENTS:Maternal thyroid parameters [TSH, free thyroid hormone (FT4), thyroid peroxidase antibody (TPO-Ab)] and foetal presentation were assessed in both groups between 35 and 38 weeks gestation. Power calculations suggested that at least 148 breech cases were required. RESULTS:The characteristics of the women in breech in both samples were similar. Women in breech (n = 58 + 131) had significantly higher TSH (but not FT4) than those (n = 1000) with cephalic presentation (Mann-Whitney U-test, P = 0·003). Different cut-offs were used to define high TSH in the 916 TPO-Ab-negative women with cephalic presentation: the 90th, 95th and 97·5th percentiles were 2·4 mIU/l (n = 149), 2·7 mIU/l (n = 77) and 3·2 mIU/l (n = 37). The prevalence rates of breech presentation in these women were all higher compared to the prevalence of breech in women below these cut-offs (df = 1, P < 0·01). The relative risk of the 149 women with a TSH >90th percentile (>2·4 mIU/l) to present in breech was 1·82 (95% CI: 1·30-2·56). CONCLUSIONS:Women with high TSH at end term are at risk for breech presentation. Substantial evidence for a relation between breech presentation and neurodevelopmental delay exists. As high TSH during gestation has also been linked to poor neurodevelopment, the relation between breech presentation and poor neurodevelopment might be thyroid-related.

journal_name

Clin Endocrinol (Oxf)

journal_title

Clinical endocrinology

authors

Kooistra L,Kuppens SM,Hasaart TH,Vader HL,Wijnen HA,Oei SG,Pop VJ

doi

10.1111/j.1365-2265.2010.03846.x

subject

Has Abstract

pub_date

2010-11-01 00:00:00

pages

661-5

issue

5

eissn

0300-0664

issn

1365-2265

pii

CEN3846

journal_volume

73

pub_type

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