Thyroid Function of Pregnant Women and Perinatal Outcomes in North Macedonia / Função tireoidiana de mulheres grávidas e resultados perinatais na Macedônia do Norte

Abstract Objective Thyroid diseases are the second most common endocrine disorders in the reproductive period of women. They can be associated with intrauterine growth restriction (IUGR), preterm delivery, low Apgar score, low birthweight (LBW) or fetal death. The aim of the present study is to explore thyroid dysfunction and its relationship with some poor perinatal outcomes (Apgar Score, low birthweight, and preterm delivery). Methods Dried blood spot samples from 358 healthy pregnant women were analyzed for thyroid stimulating hormone (TSH), total thyroxine (TT4), and thyroglobulin (Tg). Neonatal data were collected upon delivery. Four groups were formed based on thyroid function tests (TFTs). Results Of the 358 tested women, 218 (60.72%) were euthyroid. Isolated hypo thyroxinemia was present in 132 women (36.76%), subclinical hyperthyroidism in 7 women (1.94%), and overt hypothyroidism in 1 (0.28%). The perinatal outcomes IUGR (p = 0.028) and Apgar score 1 minute (p = 0.015) were significantly different between thyroid function test [TFT]-distinct groups. In the multiple regression analysis, TT4 showed a statistically significant inverse predictive impact on LBW (p < 0.0001), but a positive impact of Tg on LBW (p = 0.0351). Conclusion Thyroid hormones alone do not have a direct impact on neonatal outcomes, but the percentage of their participation in the total process cannot be neglected. Based on the regression analysis, we can conclude that TT4 and Tg can be used as predictors of neonatal outcome, expressed through birthweight and Apgar score. The present study aims to contribute to determine whether a test for thyroid status should become routine screening during pregnancy.

Resumo Objetivo As doenças da tireoide são as segundas doenças endócrinas mais comuns no período reprodutivo das mulheres. Elas podem estar associadas à restrição de crescimento intrauterino (RCIU), parto prematuro, baixo índice de Apgar, baixo peso ao nascer (BPN) ou morte fetal. O objetivo do presente estudo é explorar a disfunção tireoidiana e sua relação com alguns resultados perinatais insatisfatórios (índice de Apgar, baixo peso ao nascer e parto prematuro). Métodos Amostras secas de sangue em 358 gestantes saudáveis foram analisadas para hormônio estimulador da tireoide (TSH), tiroxina total (TT4) e tireoglobulina (Tg). Os dados neonatais foram coletados no momento do parto. Quatro grupos foram formados com base em testes de função tireoidiana (TFT). Resultados Das 358 mulheres testadas, 218 (60,72%) eram eutireoidianas. Hipotiroxinemia isolada estava presente em 132 mulheres (36,76%), hipertireoidismo subclínico em 7 mulheres (1,94%) e hipotireoidismo evidente em 1 (0,28%). Os resultados perinatais RCIU (p = 0,028) e índice de Apgar de 1 minuto (p = 0,015) foram significativamente diferentes entre os grupos distintos de TFT. Na análise de regressão múltipla, TT4 mostrou impacto preditivo inverso estatisticamente significativo no BPN (p < 0,0001), mas impacto positivo da Tg no BPN (p = 0,0351). Conclusão Isoladamente, os hormônios tireoidianos não têm impacto direto no desfecho neonatal, mas o percentual de sua participação no processo total não pode ser desprezado. Com base na análise de regressão, podemos concluir que TT4 e Tg podem ser usados como preditores do resultado neonatal, expressos por meio do peso ao nascer e do índice de Apgar. O presente estudo tem como objetivo contribuir para que um teste para verificar o estado da tireoide deva se tornar um rastreamento de rotina durante a gravidez.

Demographic characteristics in preeclamptic women in Macedonia / Características demográficas de mujeres con pre eclampsia en Macedonia

Background: Worldwide, pre-eclampsia and eclampsia contribute to the death of a pregnant woman every three minutes. Aim: To determine the demographic risk factors and values of blood pressure to predict preeclampsia. Material and Methods: Demographic and clinical features of 300 normotensive pregnant women aged 28 ±5 years and 100 preeclamptic women aged 28 ±6 years, were assessed. Women with multiple pregnancies were excluded from the study. Results: Women with less educational attainment had a higher risk of mild and severe preeclampsia. Weight gain during pregnancy in control and pre eclamptic women were 14 ±3 and 20 ±5 kg, respectively (p < 0.01). Women with severe preeclampsia had high significantly shorter gestations then the other two patient groups (p < 0.01). Compared to nor-motensive women, at 6 to 12 weeks of gestation, pre eclamptic women had higher systolic (102 ±7 and 113 ±9 mmHg respectively), diastolic ( 64 ±5 and 74 ±10 mmHg respectively) and mean arterial pressure (77 ±5 and 87 ±8.01 mmHg res-pectively). Conclusions: Women with basic education or illiterate have a higher risk of developing preeclampsia. During the first or second trimester of pregnancy, mean arterial pressure is the best predictor for preeclampsia.

Antecedentes: La pre eclampsia contribuye a la muerte de una mujer embarazada cada 3 minutos a nivel mundial. Objetivo: Analizar los factores de riesgo demográficos y los valores de presión arterial predictores de pre eclampsia. Material y Métodos: Se estudiaron las características demográficas y clínicas de 300 mujeres embarazadas con presión arterial normal de 28 ±5 años y 100 mujeres con pre eclampsia de 28 ±6 años. Resultados: Las mujeres con menor nivel educacional tuvieron un riesgo mayor de presentar pre eclampsia moderada o severa. La ganancia de peso durante el embarazo de mujeres con pre eclampsia y presión normal fue de 20 ±5 kg y 14 ±3, respectivamente (p < 0,01). Las mujeres con pre eclampsia severa tuvieron gestaciones significativamente más cortas que el resto de los grupos. Comparadas con mujeres normotensas, a las 6 a 12 semanas de gestación, las mujeres con pre eclampsia tenían mayor presión arterial sistólica (102 ±7 y 113 ±9 mmHg respectivamente), diastólica (64 ±5 y 74 ±10 mmHg respectivamente) y media (77 ±5 y 87 ±8,01 mmHg respectivamente). Conclusiones: Las mujeres analfabetas o con educación básica tienen el mayor riesgo de desarrollar pre eclampsia. La presión arterial media durante el primer trimestre es el mejor predictor de preeclampsia.