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Dose Dependency and a Functional Cutoff for TPO-Antibody Positivity During Pregnancy.
- Source :
-
The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2018 Feb 01; Vol. 103 (2), pp. 778-789. - Publication Year :
- 2018
-
Abstract
- Objective: To investigate a dose dependency of thyroperoxidase antibody (TPOAb) concentrations in relation to thyroid function and premature delivery and define a population-based, pregnancy-specific, functional cutoff for TPOAb positivity.<br />Design: Individual participant meta-analysis of three prospective birth cohorts: the Amsterdam Born Children and their Development study, and the Holistic Approach to Pregnancy.<br />Setting: Population-based studies in the Netherlands (2002 to 2014).<br />Participants: A total of 11,212 pregnant women (<20 weeks' gestation).<br />Main Outcome Measures: Thyrotropin (TSH) and FT4 concentrations, premature delivery.<br />Results: In all cohorts, there was a dose-dependent positive association of TPOAb concentrations with TSH concentrations, as well as a dose-dependent negative association with FT4 concentrations during early pregnancy (all P < 0.0001). There was a dose-dependent association of TPOAb concentrations with the risk of premature delivery, which was also modified by TSH concentrations. Women with TPOAb concentrations from the 92nd percentile upward had a higher TSH and a higher risk of a TSH >2.5 mU/L (range, 19.4% to 51.3%). Stratified analyses showed that women with TPOAb concentrations below manufacturer cutoffs already had a higher risk of premature delivery, especially when TSH concentrations were high or in the high-normal range.<br />Conclusions: This study demonstrated a dose-dependent relationship between TPOAbs and thyroid function as well as the risk of premature delivery. Furthermore, our results indicate that the currently used cutoffs for TPOAb positivity may be too high. Furthermore, the use of a population-based cutoff for TPOAbs may identify women with a clinically relevant extent of thyroid autoimmunity and a higher risk of premature delivery but that would not be considered TPOAb positive or eligible for treatment otherwise.<br /> (Copyright © 2017 Endocrine Society)
- Subjects :
- Adult
Autoantigens blood
Female
Humans
Infant, Newborn
Iodide Peroxidase blood
Iron-Binding Proteins blood
Netherlands
Pregnancy
Premature Birth diagnosis
Premature Birth immunology
Prognosis
Reference Values
Thyroid Function Tests methods
Thyroiditis, Autoimmune blood
Autoantibodies blood
Autoantigens immunology
Iodide Peroxidase immunology
Iron-Binding Proteins immunology
Pregnancy Complications blood
Thyroid Function Tests standards
Thyroiditis, Autoimmune diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1945-7197
- Volume :
- 103
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Journal of clinical endocrinology and metabolism
- Publication Type :
- Academic Journal
- Accession number :
- 29240902
- Full Text :
- https://doi.org/10.1210/jc.2017-01560