Subclinical Changes in Maternal Thyroid Function Parameters in Pregnancy and Fetal Growth

Abstract

Context Overt thyroid disease in pregnancy is a known risk factor for abnormal fetal growth and development. Data on the effects of milder forms of variation in maternal thyroid function on intrauterine growth are less well examined. Objective We explored these associations using repeated thyroid hormone and ultrasound measurements. Design, Setting, and Participants Data were obtained from 439 pregnant women without diagnosed thyroid disease who were participants in a case-control study of preterm birth nested within an ongoing prospective birth cohort in Boston, Massachusetts. Main Outcome Measures Ultrasound and delivery indices of fetal growth were standardized to those measured in a larger population. Results At median 10, 18, and 26 weeks of gestation, we observed significant inverse associations between free thyroxine (FT4) and birth weight z scores, with the strongest association detected at median 10 weeks, at which time a 10% increase in FT4 was associated with a 0.02 z score decrease (∼8.5 g) in birth weight (β = -0.41 for ln-transformed FT4; 95% confidence interval, -0.64 to -0.18). FT4 was also inversely associated with repeated measurements of estimated fetal weight, head circumference, and abdominal circumference. We observed weaker inverse associations for total T4 and a positive relationship between total triiodothyronine and birth weight z scores. We did not observe any associations for thyroid-stimulating hormone. Conclusion In pregnant women without overt thyroid disease, subclinical changes in thyroid function parameters may influence fetal growth.