Thyroid-stimulating hormone and free thyroxine fail to predict the severity and clinical course of hyperemesis gravidarum: A prospective cohort study

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Thyroid-stimulating hormone and free thyroxine fail to predict the severity and clinical course of hyperemesis gravidarum: A prospective cohort study. / Nijsten, Kelly ; Koot, Marjette H.; van der Post, Joris A. M. et al.

In: Acta obstetricia et gynecologica Scandinavica, Vol. 100, No. 8, 08.2021, p. 1419-1429.

Research output: Contribution to journal › Article › Academic › peer-review

BibTeX

@article{477dc5acc4e4417c8b1e841e0f29bdd0,

title = "Thyroid-stimulating hormone and free thyroxine fail to predict the severity and clinical course of hyperemesis gravidarum: A prospective cohort study",

abstract = "Introduction: Little is known about the pathophysiology of hyperemesis gravidarum (HG). Proposed underlying causes are multifactorial and thyroid function is hypothesized to be causally involved. In this study, we aimed to assess the utility of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) as a marker and predictor for the severity and clinical course of HG. Material and methods: We conducted a prospective cohort study including women admitted for HG between 5 and 20 weeks of gestation in 19 hospitals in the Netherlands. Women with a medical history of thyroid disease were excluded. TSH and FT4 were measured at study entry. To adjust for gestational age, we calculated TSH multiples of the median (MoM). We assessed HG severity at study entry as severity of nausea and vomiting (by the Pregnancy Unique Quantification of Emesis and nausea score), weight change compared with prepregnancy weight, and quality of life. We assessed the clinical course of HG as severity of nausea and vomiting and quality of life 1 week after inclusion, duration of hospital admissions, and readmissions. We performed multivariable regression analysis with absolute TSH, TSH MoMs, and FT4. Results: Between 2013 and 2016, 215 women participated in the cohort. TSH, TSH MoM, and FT4 were available for, respectively, 150, 126, and 106 of these women. Multivariable linear regression analysis showed that lower TSH MoM was significantly associated with increased weight loss or lower weight gain at study entry (ΔKg; β = 2.00, 95% CI 0.47-3.53), whereas absolute TSH and FT4 were not. Lower TSH, not lower TSH MoM or FT4, was significantly associated with lower nausea and vomiting scores 1 week after inclusion (β = 1.74, 95% CI 0.36-3.11). TSH and FT4 showed no association with any of the other markers of the severity or clinical course of HG. Twenty-one out of 215 (9.8%) women had gestational transient thyrotoxicosis. Women with gestational transient thyrotoxicosis had a lower quality of life 1 week after inclusion than women with no gestational transient thyrotoxicosis (p = 0.03). Conclusions: Our findings show an inconsistent role for TSH, TSH MoM, or FT4 at time of admission and provide little guidance on the severity and clinical course of HG.",

keywords = "disease severity marker, free thyroxine, hyperemesis gravidarum, nausea and vomiting in pregnancy, thyroid function, thyroid-stimulating hormone",

author = "Kelly Nijsten and Koot, {Marjette H.} and {van der Post}, {Joris A. M.} and Bais, {Joke M. J.} and Carrie Ris-Stalpers and Christiana Naaktgeboren and Bremer, {Henk A.} and {van der Ham}, {David P.} and Heidema, {Wieteke M.} and Anjoke Huisjes and Gunilla Kleiverda and Kuppens, {Simone M.} and {van Laar}, {Judith O. E. H.} and Josje Langenveld and {van der Made}, Flip and Dimitri Papatsonis and Marie-Jos{\'e} Pelinck and Pernet, {Paula J.} and {van Rheenen-Flach}, Leonie and Rijnders, {Robbert J.} and Scheepers, {Hubertina C. J.} and Siegelaar, {Sarah E.} and Tatjana Vogelvang and Mol, {Ben W.} and Roseboom, {Tessa J.} and Grooten, {Iris J.} and Painter, {Rebecca C.}",

note = "Funding Information: This prospective cohort study was supported by a research grant from North West Hospital Group, Alkmaar, the Netherlands (Grant number: 2013T085) and by a research grant from the Amsterdam Reproduction and Development (AR&D) Research Institute, Amsterdam UMC, the Netherlands (Project number: 23346). We thank Dr. J.P. Bestwick (employed at Queen Mary University of London, London, UK) and Professor Dr. J.H. Lazarus (employed at Cardiff School of Medicine, Cardiff, UK) for providing TSH medians from their study in the UK. Dr. J.P. Bestwick and Professor Dr. Lazarus have nothing to disclose. Publisher Copyright: {\textcopyright} 2021 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = aug,

doi = "10.1111/aogs.14131",

language = "English",

volume = "100",

pages = "1419--1429",

journal = "Acta obstetricia et gynecologica Scandinavica",

issn = "0001-6349",

publisher = "Wiley-Blackwell",

number = "8",

}

RIS

TY - JOUR

T1 - Thyroid-stimulating hormone and free thyroxine fail to predict the severity and clinical course of hyperemesis gravidarum: A prospective cohort study

AU - Nijsten, Kelly

AU - Koot, Marjette H.

AU - van der Post, Joris A. M.

AU - Bais, Joke M. J.

AU - Ris-Stalpers, Carrie

AU - Naaktgeboren, Christiana

AU - Bremer, Henk A.

AU - van der Ham, David P.

AU - Heidema, Wieteke M.

AU - Huisjes, Anjoke

AU - Kleiverda, Gunilla

AU - Kuppens, Simone M.

AU - van Laar, Judith O. E. H.

AU - Langenveld, Josje

AU - van der Made, Flip

AU - Papatsonis, Dimitri

AU - Pelinck, Marie-José

AU - Pernet, Paula J.

AU - van Rheenen-Flach, Leonie

AU - Rijnders, Robbert J.

AU - Scheepers, Hubertina C. J.

AU - Siegelaar, Sarah E.

AU - Vogelvang, Tatjana

AU - Mol, Ben W.

AU - Roseboom, Tessa J.

AU - Grooten, Iris J.

AU - Painter, Rebecca C.

N1 - Funding Information: This prospective cohort study was supported by a research grant from North West Hospital Group, Alkmaar, the Netherlands (Grant number: 2013T085) and by a research grant from the Amsterdam Reproduction and Development (AR&D) Research Institute, Amsterdam UMC, the Netherlands (Project number: 23346). We thank Dr. J.P. Bestwick (employed at Queen Mary University of London, London, UK) and Professor Dr. J.H. Lazarus (employed at Cardiff School of Medicine, Cardiff, UK) for providing TSH medians from their study in the UK. Dr. J.P. Bestwick and Professor Dr. Lazarus have nothing to disclose. Publisher Copyright: © 2021 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/8

Y1 - 2021/8

N2 - Introduction: Little is known about the pathophysiology of hyperemesis gravidarum (HG). Proposed underlying causes are multifactorial and thyroid function is hypothesized to be causally involved. In this study, we aimed to assess the utility of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) as a marker and predictor for the severity and clinical course of HG. Material and methods: We conducted a prospective cohort study including women admitted for HG between 5 and 20 weeks of gestation in 19 hospitals in the Netherlands. Women with a medical history of thyroid disease were excluded. TSH and FT4 were measured at study entry. To adjust for gestational age, we calculated TSH multiples of the median (MoM). We assessed HG severity at study entry as severity of nausea and vomiting (by the Pregnancy Unique Quantification of Emesis and nausea score), weight change compared with prepregnancy weight, and quality of life. We assessed the clinical course of HG as severity of nausea and vomiting and quality of life 1 week after inclusion, duration of hospital admissions, and readmissions. We performed multivariable regression analysis with absolute TSH, TSH MoMs, and FT4. Results: Between 2013 and 2016, 215 women participated in the cohort. TSH, TSH MoM, and FT4 were available for, respectively, 150, 126, and 106 of these women. Multivariable linear regression analysis showed that lower TSH MoM was significantly associated with increased weight loss or lower weight gain at study entry (ΔKg; β = 2.00, 95% CI 0.47-3.53), whereas absolute TSH and FT4 were not. Lower TSH, not lower TSH MoM or FT4, was significantly associated with lower nausea and vomiting scores 1 week after inclusion (β = 1.74, 95% CI 0.36-3.11). TSH and FT4 showed no association with any of the other markers of the severity or clinical course of HG. Twenty-one out of 215 (9.8%) women had gestational transient thyrotoxicosis. Women with gestational transient thyrotoxicosis had a lower quality of life 1 week after inclusion than women with no gestational transient thyrotoxicosis (p = 0.03). Conclusions: Our findings show an inconsistent role for TSH, TSH MoM, or FT4 at time of admission and provide little guidance on the severity and clinical course of HG.

AB - Introduction: Little is known about the pathophysiology of hyperemesis gravidarum (HG). Proposed underlying causes are multifactorial and thyroid function is hypothesized to be causally involved. In this study, we aimed to assess the utility of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) as a marker and predictor for the severity and clinical course of HG. Material and methods: We conducted a prospective cohort study including women admitted for HG between 5 and 20 weeks of gestation in 19 hospitals in the Netherlands. Women with a medical history of thyroid disease were excluded. TSH and FT4 were measured at study entry. To adjust for gestational age, we calculated TSH multiples of the median (MoM). We assessed HG severity at study entry as severity of nausea and vomiting (by the Pregnancy Unique Quantification of Emesis and nausea score), weight change compared with prepregnancy weight, and quality of life. We assessed the clinical course of HG as severity of nausea and vomiting and quality of life 1 week after inclusion, duration of hospital admissions, and readmissions. We performed multivariable regression analysis with absolute TSH, TSH MoMs, and FT4. Results: Between 2013 and 2016, 215 women participated in the cohort. TSH, TSH MoM, and FT4 were available for, respectively, 150, 126, and 106 of these women. Multivariable linear regression analysis showed that lower TSH MoM was significantly associated with increased weight loss or lower weight gain at study entry (ΔKg; β = 2.00, 95% CI 0.47-3.53), whereas absolute TSH and FT4 were not. Lower TSH, not lower TSH MoM or FT4, was significantly associated with lower nausea and vomiting scores 1 week after inclusion (β = 1.74, 95% CI 0.36-3.11). TSH and FT4 showed no association with any of the other markers of the severity or clinical course of HG. Twenty-one out of 215 (9.8%) women had gestational transient thyrotoxicosis. Women with gestational transient thyrotoxicosis had a lower quality of life 1 week after inclusion than women with no gestational transient thyrotoxicosis (p = 0.03). Conclusions: Our findings show an inconsistent role for TSH, TSH MoM, or FT4 at time of admission and provide little guidance on the severity and clinical course of HG.

KW - disease severity marker

KW - free thyroxine

KW - hyperemesis gravidarum

KW - nausea and vomiting in pregnancy

KW - thyroid function

KW - thyroid-stimulating hormone

UR - http://www.scopus.com/inward/record.url?scp=85102373591&partnerID=8YFLogxK

U2 - 10.1111/aogs.14131

DO - 10.1111/aogs.14131

M3 - Article

C2 - 33606270

VL - 100

SP - 1419

EP - 1429

JO - Acta obstetricia et gynecologica Scandinavica

JF - Acta obstetricia et gynecologica Scandinavica

SN - 0001-6349

IS - 8

ER -

ID: 17469376

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