The results of a four-year international project led by Spyridoula Maraka, MD, MS, assistant professor of medicine at the University of Arkansas for Medical Sciences (UAMS), were published this month in the medical journal The Lancet Diabetes & Endocrinology, clarifying an association between maternal thyroid function and risk of gestational hypertension.
The Lancet Diabetes & Endocrinology is part of The Lancet family of peer-reviewed journals. Founded in 1823 and based in the UK, The Lancet is one of the oldest and most respected medical journals in the world.
Maraka, who is the director of the endocrinology fellowship program at UAMS, spearheaded the first-ever project to examine the association of gestational thyroid disease with gestational hypertension and preeclampsia, using a meta-analysis of individual participant data from prospective cohort studies around the world. She is also a member of the American Thyroid Association task force for updating guidelines for the diagnosis and management of thyroid disease in pregnancy.
Maraka and lead author Freddy Toloza Bonilla, MD, a former UAMS researcher who is now a UAMS research associate and internal medicine resident at MetroWest Medical Center in Framingham, Massachusetts, worked closely with researchers from Erasmus University Medical Center in the Netherlands and the Thyroid and Pregnancy Consortium, an international endocrinology research collaboration that aims to analyze studies examining the diagnosis, risk factors and clinical impact of gestational thyroid disease .
The study found that subclinical hypothyroidism, a condition of mild thyroid deficiency, was associated with a higher risk of preeclampsia and the composite outcome of gestational hypertension or preeclampsia. A higher and lower concentration of thyroid-stimulating hormone (a marker of thyroid condition) was associated with a higher risk of preeclampsia.
“Hypertensive disorders such as preeclampsia are among the leading causes of death among pregnant women and their fetuses, especially in third world countries,” Toloza said. “The association between thyroid function abnormalities and hypertensive disorders of pregnancy has been assessed in several studies with inconsistent results, which may be due to methodological issues.
“Our approach has allowed us to obtain robust and unbiased results that can be easily applied in clinical guidelines and can form the basis for future research,” Maraka said. “This approach is a very efficient way to add a lot of new data to the field by immediately reanalyzing previously collected data, according to today’s standards.”
The authors conclude, “These findings have potential implications for defining the optimal treatment target in women treated with levothyroxine (thyroid hormone) during pregnancy, which needs to be evaluated in future interventional studies.”
Funding for the study came from the Arkansas Institute of Biosciences at UAMS and the Netherlands Organization for Scientific Research.