Main Article Content
Thyroid stimulating hormones, Neonates, Maternal factors, Neonatal factors
Background and Aim: Thyroid hormones are critical for fetal growth and development, especially of the central nervous system. The primary regulating hormone is thyroid stimulating hormone (TSH). The present study aimed to determine the effect of maternal and neonatal variables on the thyroid-stimulating hormones levels in neonates.
Patients and Methods: This retrospective study was carried out on 856 newborns delivered in Ghurki Trust and Teaching Hospital, Lahore – Pakistan from 6th March 2022 to 5th April 2023. Within 48-72 hours of delivery, all neonates were investigated for neonatal-TSH (n-TSH). TSH was measured using a fuorometric enzyme immunoassay on a dried blood spot. Maternal variables included demographic status, clinical history, and obstetric history. As neonatal factors, anthropometric measures at birth and clinical information were recorded. SPSS version 27 was used for descriptive statistics.
Results: The overall mean maternal age was 29.28±3.84 years. The mean birth weight of neonates was 2720.23±556.98 gram. Mean gestational age was 38.58±2.978 weeks. Overall mean parity and maternal Hb (g/dl) was 1.48±0.95 and 11.48±1.216 respectively. An n-TSH showed a significant connection with maternal age whereas the maternal blood hemoglobin levels showed a significant negative connection. A slight change was observed in TSH levels with neonate’s birth weight. Neonates of first order, delivered normally at term or preterm, and need post birth resuscitation had significantly higher TSH levels.
Conclusion: The present study found that neonates of first order, delivered normally at term or preterm, and need post birth resuscitation had significantly higher TSH levels. . However, additional factors may exacerbate the impact, and these aspects should be addressed when evaluating the screening program's results.
2. Li S, Wu Y, Zhang SJ, Li G, Xiang YT, Zhang WZ, Pan WJ, Chen WQ, Hao YT, Ling WH, Liu ZM. Higher maternal thyroid resistance indices were associated with increased neonatal thyroid-stimulating hormone—analyses based on the Huizhou mother-infant cohort. Frontiers in Endocrinology. 2022 Sep 30;13:937430.
3. Shettian N, Pavuluri HV. Correlation between maternal thyroid stimulating hormone and birth weight of neonate. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2022 Jan 1;11(1):55-9.
4. Cao Z, Li J, Yang M, Gong H, Xiang F, Zheng H, Cai X, Xu S, Zhou A, Xiao H. Prenatal exposure to perfluorooctane sulfonate alternatives and associations with neonatal thyroid stimulating hormone concentration: A birth cohort study. Chemosphere. 2022 Jan 1;311:136940.
5. Zhang Y et al (2018) Efect of maternal and neonatal factors on neonatal thyroid stimulating hormone: Results from a population-based prospective cohort study in China. J. Trace Elem. Med. Biol. 49:151–156
6. Sahoo PK, Swain A, Sahoo G, Mohanty S, Barik K (2020) Newborn screening for congenital hypothyroidism in institutional set up in an urban area in odisha. Int. J. Curr. Res. Rev. 12:179–182
7. Lee SY (2016) perinatal factors associated with neonatal thyroid-stimulating hormone in normal newborns. Ann. Pediatr. Endocrinol. Metab. 21:206–211.
8. Ryckman KK, Spracklen CN, Dagle JM, M. (2014) J. Maternal factors and complications of preterm birth associated with neonatal thyroid stimulating hormone. J. Pediatr. Endocrinol. Metab. Sep 20:929–938.
9. Trumpf C et al (2015) Neonatal thyroid-stimulating hormone level is infuenced by neonatal, maternal, and pregnancy factors. Nutr. Res. 35:975–981.
10. Mohammad A, Roya K, Ziba F, Azadeh E, Mahin H (2013) Infuence of perinatal factors on thyroid stimulating hormone level in cord blood. Adv. Biomed. Res. 2:48.
11. American College of Obstetricians and Gynecologists (2020) Thyroid disease in pregnancy: ACOG practice bulletin, number 223. Obstetr Gynecol 135:e261–e274.
12. Lakshminarayana SG, Sadanandan NP, Mehaboob AK, Gopaliah LR. Effect of maternal and neonatal factors on cord blood thyroid stimulating hormone. Indian J Endocr Metab 2016;20:317-23.
13. Attarian E, Ebrahimpour K, Maracy M, Daniali SS, Shoshtari-Yeganeh B, Moazeni M, Ebrahimi A, Kelishadi R. Effect of Maternal Triclosan Exposure on Neonatal Thyroid-Stimulating Hormone Levels: A Cross-Sectional Study. Journal of Environmental and Public Health. 2022 Sep 28;2022.
14. Lee SY. Perinatal factors associated with neonatal thyroid-stimulating hormone in normal newborns. Ann Pediatr Endocrinol Metab. (2016) 21:206–11. 10.6065/apem.2016.21.4.206.
15. Lain S, Trumpff C, Grosse SD, Olivieri A, Van Vliet G. Are lower TSH cutoffs in neonatal screening for congenital hypothyroidism warranted? Eur J Endocrinol. (2017) 177:D1–D12. 10.1530/EJE-17-0107.
16. Di Dalmazi G, Carlucci MA, Semeraro D, Giuliani C, Napolitano G, Caturegli P, et al. A detailed analysis of the factors influencing neonatal TSH: Results from a 6-year congenital hypothyroidism screening program. Front endocrinology (2020) 11:456. doi: 10.3389/fendo.2020.00456
17. Hashemipour M, Hovsepian S, Ansari A, Keikha M, Khalighinejad P, Niknam N. Screening of congenital hypothyroidism in preterm, low birth weight and very low birth weight neonates: a systematic review. Pediatr Neonatol. (2017) 59:3–14. 10.1016/j.pedneo.2017.04.006
18. DeMartino L, McMahon R, Caggana M, Tavakoli NP. Gender disparities in screening for congenital hypothyroidism using thyroxine as a primary screen. Eur J Endocrinol. (2018) 179:161–7. 10.1530/EJE-18-0399.
19. Bosch-Gimenez VM, Palazon-Bru A, Blasco-Barbero A, Juste-Ruiz M, Rizo-Baeza MM, Cortes-Castell E. Multivariate analysis of thyrotropin in preterm newborns based on adequacy of weight for gestational age. Thyroid. (2017) 27:120–4. 10.1089/thy.2016.0338.
20. Trumpff C, Vandevijvere S, Moreno-Reyes R, Vanderpas J, Tafforeau J, Van Oyen H, et al.. Neonatal thyroid-stimulating hormone level is influenced by neonatal, maternal, pregnancy factors. Nutr Res. (2015) 35:975–81. 10.1016/j.nutres.2015.09.002.
21. Kilberg MJ, Rasooly IR, LaFranchi SH, Bauer AJ, Hawkes CP. Newborn screening in the US may miss mild persistent hypothyroidism. J Pediatr. (2018) 192:204–8. 10.1016/j.jpeds.2017.09.003.
22. Caylan N, Tezel B, Ozbas S, Sahin N, Aydin S, Acican D, et al.. Neonatal thyroid-stimulating hormone screening as a monitoring tool for iodine deficiency in Turkey. J Clin Res Pediatr Endocrinol. (2016) 8:187–91. 10.4274/jcrpe.2526.
23. Kanike N, Davis A, Shekhawat PS. Transient hypothyroidism in the newborn: to treat or not to treat. Transl Pediatr. (2017) 6:349–58. 10.21037/tp.2017.09.07.
24. Korevaar TI, Chaker L, Jaddoe VW, Visser TJ, Medici M, Peeters RP. Maternal and birth characteristics are determinants of offspring thyroid function. J Clin Endocrinol Metab (2016) 101(1):206–13. doi: 10.1210/jc.2015-3559.
25. Eng L, Lam L. Thyroid function during the fetal and neonatal periods. Neoreviews (2020) 21(1):e30–e6. doi: 10.1542/neo.21-1-e30.
26. Plowden TC, Schisterman EF, Sjaarda LA, Perkins NJ, Silver R, Radin R, et al. Thyroid-stimulating hormone, anti-thyroid antibodies, and pregnancy outcomes. Am J obstetrics gynecology (2017) 217(6):697.e1–.e7. doi: 10.1016/j.ajog.2017.09.001.
27. C. Trumpff et al. Neonatal thyroid-stimulating hormone level is influenced by neonatal, maternal, and pregnancy factors Nutr. Res. (2015)
28. Fan P, Luo Z-C, Tang N, Wang W, Liu Z, Zhang J, et al. Advanced maternal age, mode of delivery, and thyroid hormone levels in Chinese newborns. Frontiers in Endocrinology. 2020;10:913.
29. Islam N, Kabir S, Mohsin F, Mahbuba S, Zabeen B, Baki A, et al. Neuro-developmental status of children with congenital hypothyroidism: experience in a tertiary hospital of Bangladesh. BIRDEM Medical Journal. 2021;11(1):63 − 6.
30. Poyekar S, Pratinidhi S, Prasad SS, Sardar ZS, Kankariya B, Bhole O. Cord blood thyroid stimulating hormone level-and the influence of perinatal and other factors on it. Pediatric Oncall Journal. 2019;16(3):79–82.
31. Pourshirazi M, Heidarzadeh M, Taheri M, Esmaily H, Babaey F, Talkhi N, et al. Cesarean delivery in Iran: a population-based analysis using the Robson classification system. BMC Pregnancy and Childbirth. 2022;22(1):1–9
32. Yarahmadi S, Azhang N, Nikkhoo B, Rahmani K. A success story: review of the implementation and achievements of the National Newborn Screening Program for congenital hypothyroidism in Iran. International journal of endocrinology and metabolism. 2020;18(2).
33. Verma N, Naik G, Patel S, Padhi P, Naik T, Nanda R. A detailed observational study of maternal and neonatal variables affecting the thyroid-stimulating hormone levels in neonates. Egyptian Pediatric Association Gazette. 2021;69:1–9.
34. Scavone M, Giancotti L, Anastasio E, Pensabene L, Sestito S, Concolino D. Evolution of congenital hypothyroidism in a cohort of preterm born children. Pediatrics & Neonatology. 2020;61(6):629 − 36