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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (5): 886-892. doi: 10.19723/j.issn.1671-167X.2023.05.017

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Association of maternal isolated thyroid peroxidase antibody positive in the first trimester with fetal growth

Jin-hui XU1,Na HAN2,Tao SU2,Li-zi LIN3,Yue-long JI1,Shuang ZHOU1,He-ling BAO1,Zheng LIU1,Shu-sheng LUO1,Xiang-rong XU1,Hai-jun WANG1,*()   

  1. 1. Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
    2. Tongzhou Maternal and Child Health Hospital of Beijing, Beijing 101101, China
    3. Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
  • Received:2021-02-23 Online:2023-10-18 Published:2023-10-09
  • Contact: Hai-jun WANG E-mail:whjun@pku.edu.cn
  • Supported by:
    the National Natural Science Foundation of China(92046019);the National Natural Science Foundation of China(81973053)

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Abstract:

Objective: To investigate the association of isolated thyroid peroxidase antibody (TPOAb) positive in the first trimester with fetal growth. Methods: A total of 16 446 pregnant women were included in the birth cohort study, whose last menstrual period was between May 2016 and April 2019 and with singleton pregnancy. Maternal serum samples were collected when they firstly came for prenatal care in the first trimester. The pregnant women were consecutively seen and followed in the hospital and the information of pregnant women was extracted from the electronic medical information system. The pregnant women were divided into isolated TPOAb positive group (n=1 654) and euthyroid group (n=14 792). Three fetal ultrasound examinations were scheduled during the routine prenatal visits at the hospital and were performed by trained sonographers. All fetal growth indicators were quantified as gestational age- and gender- adjusted standard deviation score (Z-score) using the generalized additive models for location, scale and shape (GAMLSS). Fetal growth indicators included estimated fetal weight (EFW), abdominal circumference (AC), biparietal diameter (BPD), femur length (FL) and head circumference (HC). Fetal growth restriction (FGR) was defined as AC or EFW Z-score＜3rd centile based on clinical consensus. Generalized estimating equation (GEE) analysis was applied to assess the association of maternal isolated TPOAb positive with fetal growth. The generalized linear model was further used to analyze the association between isolated TPOAb positive and fetal growth indicator at different gestational ages when the fetal growth indicator was significantly associated with isolated TPOAb positive in the GEE mo-del. Results: The median gestational age at three ultrasound measurements was 23.6 (23.3, 24.1), 30.3 (29.7, 30.9), 37.3 (37.0, 37.7) weeks, respectively. The BPD Z-score was higher in isolated TPOAb positive women, compared with the euthyroid pregnant women after adjustment (β=0.057, 95%CI: 0.014-0.100, P=0.009). The generalized linear model showed the BPD Z-score was higher in the isolated TPOAb positive women at the end of 21-25 weeks (β=0.052, 95%CI: 0.001-0.103, P=0.044), 29-32 weeks (β=0.055, 95%CI: 0.004-0.107, P=0.035) and 36-40 weeks (β=0.068, 95%CI: 0.011-0.125, P=0.020), compared with the euthyroid pregnant women. There was no difference in other fetal growth indicators (EFW, AC, FL and HC) and FGR between the isolated TPOAb positive and euthyroid pregnant women. Conclusion: The BPD Z-score was slightly increased in the isolated TPOAb positive pregnant women in the first trimester, while other fetal growth indicators were not changed. The reproducibility and practical significance of this result need to be confirmed.

Key words: Thyroid peroxidase antibody, Pregnancy trimester, first, Fetal development, Thyroid di-seases

CLC Number: 

  • R714.256

Table 1

Characteristics of isolated TPOAb positive and euthyroid pregnant women"

Items Isolated TPOAb positive (n=1 654) Euthyroid(n=14 792) P value
Maternal age/years 29.6 (27.2, 32.6) 29.4 (27.1, 32.2) 0.021
Maternal education levels 0.005
    Low (high school and below) 232 (14.0) 2 299 (15.5)
    Middle (vocational college) 670 (40.5) 6 378 (43.1)
    High (university and above) 752 (45.5) 6 115 (41.3)
Current employment status 0.115
    Yes 1 479 (89.4) 13 027 (88.1)
    No 175 (10.6) 1 765 (11.9)
Parity 0.918
    Primipara 925 (55.9) 8 297 (56.1)
    Multipara 729 (44.1) 6 495 (43.9)
Pre-pregnancy BMI 0.637
    Underweight 165 (10.0) 1 443 (9.8)
    Normal weight 1 052 (63.6) 9 599 (64.9)
    Overweight 348 (21.0) 2 928 (19.8)
    Obesity 89 (5.4) 822 (5.6)
Gestational age at thyroid function testing/weeks 9.0 (8.0, 10.1) 9.0 (8.0, 10.3) 0.623
TSH/(mIU/L) 1.1 (0.7, 1.6) 0.9 (0.5, 1.3) ＜ 0.001
FT4/(pmol/L) 13.5 (12.5, 14.7) 13.6 (12.7, 14.8) ＜ 0.001

Table 2

Fetal growth parameters of isolated TPOAb positive and euthyroid pregnant women during pregnancy"

Items 21-25 weeks 29-32 weeks 36-40 weeks
Euthyroid
(n=14 285)		 Isolated TPOAb positive
(n=1 606)		 Euthyroid
(n=14 037)		 Isolated TPOAb positive
(n=1 569)		 Euthyroid
(n=11 466)		 Isolated TPOAb positive
(n=1 273)
EFW/g 614.79±68.02 614.98±66.39 1529.19±181.38 1531.23±183.37 2935.17±305.42 2949.79±318.00
    Z-score -0.14±0.99 -0.13±0.98 0.00±0.99 0.00±0.99 -0.04±0.98 -0.01±1.00
AC/cm 19.07±0.92 19.08±0.92 26.11±1.27 26.14±1.28 33.04±1.54 33.10±1.59
    Z-score -0.02±0.98 0.00±0.99 -0.01±0.99 0.00±0.99 -0.03±0.98 0.00±1.00
BPD/cm 5.80±0.29 5.82±0.29 7.74±0.33 7.76±0.34 9.14±0.32 9.16±0.32
    Z-score -0.02±0.99 0.03±0.99 -0.01±0.99 0.05±1.00 -0.03±0.98 0.04±0.99
FL/cm 4.13±0.19 4.13±0.19 5.65±0.23 5.64±0.24 6.86±0.22 6.86±0.23
    Z-score -0.02±0.99 -0.03±0.98 0.00±0.99 -0.06±0.99 -0.02±0.98 -0.03±1.00
HC/cm 21.45±0.86 21.44±0.87 28.07±1.01 28.12±1.05 32.46±1.03 32.54±1.04
    Z-score -0.02±0.99 -0.01±0.99 -0.01±0.98 0.04±0.99 -0.03±0.98 0.04±0.99
FGR/% 607 (4.3) 62 (3.9) 535 (3.8) 57 (3.6) 407 (3.6) 52 (4.1)

Table 3

Association of maternal isolated TPOAb positive with fetal growth"

ItemsAdjust model 1 Adjusted model 2
β or RR (95%CI) P value β or RR (95%CI) P value
EFW 0.007 (-0.036, 0.049) 0.760 0.012 (-0.031, 0.055) 0.590
AC 0.016 (-0.025, 0.057) 0.451 0.020 (-0.022, 0.061) 0.349
BPD 0.054 (0.011, 0.097) 0.013 0.057 (0.014, 0.100) 0.009
FL -0.026 (-0.068, 0.016) 0.224 -0.020 (-0.062, 0.023) 0.358
HC 0.028 (-0.013, 0.070) 0.183 0.031 (-0.011, 0.073) 0.148
FGR 1.02 (0.85, 1.21) 0.862 1.01 (0.84, 1.21) 0.922

Table 4

Association of maternal isolated TPOAb positive with BPD Z-score at different gestational weeks"

ItemsAdjust model 1 Adjusted model 2
β (95%CI) P value β (95%CI) P value
21-25 weeks 0.049 (-0.001, 0.100) 0.056 0.052 (0.001, 0.103) 0.044
29-32 weeks 0.049 (-0.002, 0.100) 0.060 0.055 (0.004, 0.107) 0.035
36-40 weeks 0.066 (0.010, 0.123) 0.022 0.068 (0.011, 0.125) 0.020
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