Accueil Recherche NouveautésEmail webmaster Tous les textes - FMCSommaire généralPage précédente
Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence
BMJ 2011; 342:d2616 [Texte complet]
Shakila Thangaratinam, senior lecturer/consultant in obstetrics and gynaecology and clinical epidemiology1, Alex Tan, academic foundation trainee2, Ellen Knox, consultant obstetrician/subspecialist in fetal medicine3, Mark D Kilby, professor of fetal medicine23, Jayne Franklyn, professor of medicine2, Arri Coomarasamy, reader/consultant gynaecologist/subspecialist in reproductive medicine and surgery2

Trois fois plus de risque de fausse-coucheen en présence
d'anticorps anti-thyroïdiens

Selon les auteurs, de 6 à 20 %. les jeunes femmes en âge de procréer ont des anticorps anti-thyroïdiens.
Une méta-analyse sur 31 études ayant inclus au total plus de 12 000 patientes a évalué la relation entre anticorps anti-thyroïdiens et fausse-couche (interruption spontanée de la grossesse avant 24 semaines). Les résultats de cette méta-analyse sont convaincants, puisque sur les 31 études, 28 trouvent une association entre auto-anticorps et avortement spontané, y compris chez des femmes en euthyroïdie.
L'existence de ces auto-anticorps anti-thyroïdiens fait plus que tripler le risque de fausse-couche.
Seulement 2 études évaluent l'effet d'un traitement par hormone thyroïdienne chez ces patientes. Elles montrent toutes deux une réduction de 52 % du risque de fausse-couche et l'une d'elle montre une diminution de 69 % de celui d'accouchement prématuré. Ces résultats demandent à être confirmés

Revoir :
---- Les anticorps anti-thyroïdiens [Lire]
---- Grossesse et thyroïde [Lire]

Objectives To evaluate the association between thyroid autoantibodies and miscarriage and preterm birth in women with normal thyroid function. To assess the effect of treatment with levothyroxine on pregnancy outcomes in this group of women.

Design Systematic review and meta-analysis. Data sources Medline, Embase, Cochrane Library, and SCISEARCH (inception-2011) without any language restrictions. We used a combination of key words to generate two subsets of citations, one indexing thyroid autoantibodies and the other indexing the outcomes of miscarriage and preterm birth.

Study selection Studies that evaluated the association between thyroid autoantibodies and pregnancy outcomes were selected in a two stage process. Two reviewers selected studies that met the predefined and explicit criteria regarding population, tests, and outcomes.

Data synthesis Odds ratios from individual studies were pooled separately for cohort and case-control studies with the random effects model.

Results 30 articles with 31 studies (19 cohort and 12 case-control) involving 12?126 women assessed the association between thyroid autoantibodies and miscarriage. Five studies with 12?566 women evaluated the association with preterm birth. Of the 31 studies evaluating miscarriage, 28 showed a positive association between thyroid autoantibodies and miscarriage. Meta-analysis of the cohort studies showed more than tripling in the odds of miscarriage with the presence of thyroid autoantibodies (odds ratio 3.90, 95% confidence interval 2.48 to 6.12; P<0.001). For case-control studies the odds ratio for miscarriage was 1.80, 1.25 to 2.60; P=0.002). There was a significant doubling in the odds of preterm birth with the presence of thyroid autoantibodies (2.07, 1.17 to 3.68; P=0.01). Two randomised studies evaluated the effect of treatment with levothyroxine on miscarriage. Both showed a fall in miscarriage rates, and meta-analysis showed a significant 52% relative risk reduction in miscarriages with levothyroxine (relative risk 0.48, 0.25 to 0.92; P=0.03). One study reported on the effect of levothyroxine on the rate of preterm birth, and noted a 69% relative risk reduction (0.31, 0.11 to 0.90).

Conclusion The presence of maternal thyroid autoantibodies is strongly associated with miscarriage and preterm delivery. There is evidence that treatment with levothyroxine can attenuate the risks.
.
Accueil NouveautésEmail webmaster Sommaire FMC Sommaire généralPage précédente