ABSTRACT
OBJECTIVE: To evaluate thyroid function and the prevalence of thyroid peroxidase (TPO) antibody and autoimmunity in African-American and white women during pregnancy and the postpartum period. METHODS: Five hundred eighty-nine women were evaluated prospectively. Serum thyroid-stimulating hormone (TSH), free thyroxine (T4), and TPO, Ro, and La antibodies were obtained during pregnancy, at delivery, and postpartum. Levels of hCG were determined during pregnancy. Urinary iodine levels were evaluated in the third trimester in another group of women. All TPO antibody-positive patients were to be followed up at 3 and 6 months postpartum. RESULTS: African-American women had lower TSH values than white women at all times. Thyroid-stimulating hormone increased, and free T4 decreased from the first to third trimester of pregnancy for both groups. African Americans had higher hCG levels than whites in the first trimester but not in the third trimester. There was no difference in urine iodine excretion between African-American and white women. Finally, there was no difference in TPO antibody seropositivity between African-American and white women. Overall, 5 patients (0.8%) were diagnosed with subclinical hypothyroidism during pregnancy. CONCLUSION: Fluctuations in TSH and free T4 during pregnancy parallel reported obstetric values. African Americans demonstrated consistently lower TSH levels than whites. These differences were unexplained by racial differences in either TPO antibody seropositivity, iodine status, or chorionic gonadotropin levels.
Subject(s)
Autoimmunity/physiology , Black or African American/statistics & numerical data , Pregnancy Complications/ethnology , Pregnancy Outcome , Thyroid Diseases/ethnology , White People/statistics & numerical data , Adult , Age Distribution , Autoimmunity/immunology , Cohort Studies , Female , Follow-Up Studies , Gestational Age , Humans , Hyperthyroidism/diagnosis , Hyperthyroidism/ethnology , Hypothyroidism/diagnosis , Hypothyroidism/ethnology , Incidence , Infant, Newborn , Maternal Age , Parity , Postpartum Period , Pregnancy , Pregnancy Complications/diagnosis , Probability , Prospective Studies , Risk Assessment , Thyroid Diseases/diagnosis , Thyroid Function TestsABSTRACT
We are continually reminded that the preterm birth rate has failed to improve; in fact, it has increased over the last 20 years. Much of this increase is related to the tremendous strides made by neonatologists and the resulting increased willingness of obstetricians to deliver preterm babies from hostile intrauterine environments. However, there is still much to learn concerning the pathogenesis, accurate early detection, treatment, and prevention of spontaneous preterm labor. This article concentrates on the clinical diagnosis and acute management of this enigmatic clinical problem.
Subject(s)
Obstetric Labor, Premature/physiopathology , Obstetric Labor, Premature/therapy , Uterine Contraction , Acute Disease , Adrenergic beta-2 Receptor Agonists , Adrenergic beta-Agonists/therapeutic use , Anticonvulsants/therapeutic use , Bed Rest , Calcium Channel Blockers/therapeutic use , Causality , Cyclooxygenase Inhibitors/therapeutic use , Ethanol/therapeutic use , Female , Humans , Magnesium Sulfate/therapeutic use , Phosphodiesterase Inhibitors/therapeutic use , Pregnancy , Tocolysis/methodsABSTRACT
The results obtained from current systematic overview do not support the routine administration of maintenance tocolytic treatment after parenteral tocolytic therapy has halted acute preterm labor. Eliminating or reducing such routine maintenance therapy, therefore, could substantially decrease costs and side effects associated with managing preterm labor without compromising perinatal outcomes. It remains to be elucidated whether it will become possible to accurately identify some groups of pregnancies for which maintenance tocolysis would be beneficial.
