{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:20:15Z","timestamp":1792790415253,"version":"4.5.0"},"reference-count":40,"publisher":"The Endocrine Society","issue":"5","license":[{"start":{"date-parts":[[2019,12,15]],"date-time":"2019-12-15T00:00:00Z","timestamp":1576368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32DK007201-37"],"award-info":[{"award-number":["T32DK007201-37"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1UL1TR001430"],"award-info":[{"award-number":["1UL1TR001430"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23ES028736"],"award-info":[{"award-number":["K23ES028736"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>The effects of maternal subclinical hypothyroidism on pregnancy outcomes are not clear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We aimed to assess potential associations between maternal thyrotropin (thyroid-stimulating hormone [TSH]) levels in pregnancy and obstetric and perinatal outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Tertiary academic medical center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>Women aged \u226518 years with a singleton gestation and no known thyroid disease seen for prenatal care at Boston Medical Center from January 1, 2003 through May 22, 2014, and their fetuses and infants were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Risk ratios of adverse obstetric and perinatal outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 8,413 pregnant women (mean age 29.1 years, 15% white, 60% black, 13% Hispanic) and their fetuses and infants (mean gestational age at birth 38.5 weeks, 52% male, mean birth weight 3.2 kg) were included in the analyses. The median (interquartile range) TSH level was 1.06(0.62\u20131.60) mIU\/L, and 130 women (1.6%) had TSH &amp;gt; 4 mIU\/L. Maternal TSH levels &amp;gt; 4 mIU\/L were associated with increased risks of prematurity (risk ratio [RR] 2.17 [95% confidence interval 1.15\u20134.07] P = .016) and neonatal respiratory distress syndrome (RDS) (RR 2.83 [95% confidence interval 1.02\u20137.86] P = .046) compared to TSH levels \u2264 4 mIU\/L. Although not statistically significant, TSH levels &amp;gt; 4 mIU\/L were also associated with increased RRs for fetal loss, preeclampsia\/eclampsia, and low birth weight. TSH levels &amp;gt; 4 mIU\/L were not associated with preterm labor, placental abruption, cesarean section, gestational hypertension or diabetes, or neonatal intensive care unit admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Maternal serum TSH concentration &amp;gt; 4 mIU\/L in pregnancy was associated with approximately 2-fold increased risks of prematurity and RDS in offspring. Elevated TSH was also associated with statistically non-significant increases in the risk of fetal loss, preeclampsia\/eclampsia, and low birth weight.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgz275","type":"journal-article","created":{"date-parts":[[2019,12,15]],"date-time":"2019-12-15T06:57:20Z","timestamp":1576393040000},"page":"e2015-e2023","source":"Crossref","is-referenced-by-count":130,"title":["Associations Between Maternal Thyroid Function in Pregnancy and Obstetric and Perinatal Outcomes"],"prefix":"10.1210","volume":"105","author":[{"given":"Sun Y","family":"Lee","sequence":"first","affiliation":[{"name":"Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA, US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard J","family":"Cabral","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Boston University School of Public Health, Boston, MA, US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Aschengrau","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Boston University School of Public Health, Boston, MA, US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth N","family":"Pearce","sequence":"additional","affiliation":[{"name":"Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA, US"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2019,12,15]]},"reference":[{"issue":"4","key":"2021031913432129400_CIT0001","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1007\/s12311-008-0069-1","article-title":"The role of thyroid hormone on cerebellar development","volume":"7","author":"Koibuchi","year":"2008","journal-title":"Cerebellum."},{"issue":"7","key":"2021031913432129400_CIT0002","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1210\/jcem-27-7-945","article-title":"Onset of function in the human fetal thyroid: biochemical and radioautographic studies from organ culture","volume":"27","author":"Shepard","year":"1967","journal-title":"J Clin Endocrinol Metab."},{"issue":"16","key":"2021031913432129400_CIT0003","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1056\/NEJM199410203311608","article-title":"Maternal and fetal thyroid function","volume":"331","author":"Burrow","year":"1994","journal-title":"N Engl J Med."},{"issue":"8","key":"2021031913432129400_CIT0004","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1056\/NEJM199102213240805","article-title":"Maturation of the secretion of thyroid hormone and thyroid-stimulating hormone in the fetus","volume":"324","author":"Thorpe-Beeston","year":"1991","journal-title":"N Engl J Med."},{"issue":"2","key":"2021031913432129400_CIT0005","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1210\/jcem-71-2-276","article-title":"Regulation of maternal thyroid during pregnancy","volume":"71","author":"Glinoer","year":"1990","journal-title":"J Clin Endocrinol Metab."},{"issue":"3","key":"2021031913432129400_CIT0006","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1089\/thy.2016.0457","article-title":"2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum","volume":"27","author":"Alexander","year":"2017","journal-title":"Thyroid."},{"issue":"3","key":"2021031913432129400_CIT0007","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1136\/jms.7.3.127","article-title":"Maternal thyroid deficiency and pregnancy complications: implications for population screening","volume":"7","author":"Allan","year":"2000","journal-title":"J Med Screen."},{"issue":"1","key":"2021031913432129400_CIT0008","first-page":"108","article-title":"Hypothyroidism complicating pregnancy","volume":"72","author":"Davis","year":"1988","journal-title":"Obstet Gynecol."},{"issue":"3","key":"2021031913432129400_CIT0009","first-page":"349","article-title":"Perinatal outcome in hypothyroid pregnancies","volume":"81","author":"Leung","year":"1993","journal-title":"Obstet Gynecol."},{"issue":"5","key":"2021031913432129400_CIT0010","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1111\/j.1365-2265.2005.02382.x","article-title":"Maternal hypothyroidism in early and late gestation: effects on neonatal and obstetric outcome","volume":"63","author":"Idris","year":"2005","journal-title":"Clin Endocrinol (Oxf)."},{"issue":"11","key":"2021031913432129400_CIT0011","doi-asserted-by":"crossref","first-page":"1642","DOI":"10.1089\/thy.2014.0029","article-title":"Maternal subclinical hypothyroidism, thyroid autoimmunity, and the risk of miscarriage: a prospective cohort study","volume":"24","author":"Liu","year":"2014","journal-title":"Thyroid."},{"issue":"6","key":"2021031913432129400_CIT0012","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1530\/EJE-08-0953","article-title":"Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death","volume":"160","author":"Benhadi","year":"2009","journal-title":"Eur J Endocrinol."},{"issue":"9","key":"2021031913432129400_CIT0013","doi-asserted-by":"crossref","first-page":"E44","DOI":"10.1210\/jc.2010-0340","article-title":"Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy","volume":"95","author":"Negro","year":"2010","journal-title":"J Clin Endocrinol Metab."},{"issue":"3","key":"2021031913432129400_CIT0014","first-page":"322","article-title":"Effects of maternal subclinical hypothyroidism on obstetrical outcomes during early pregnancy","volume":"35","author":"Wang","year":"2012","journal-title":"J Endocrinol Invest."},{"issue":"1","key":"2021031913432129400_CIT0015","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1089\/105072502753451986","article-title":"Overt and subclinical hypothyroidism complicating pregnancy","volume":"12","author":"Abalovich","year":"2002","journal-title":"Thyroid."},{"issue":"11","key":"2021031913432129400_CIT0016","doi-asserted-by":"crossref","first-page":"4382","DOI":"10.1210\/jc.2013-2855","article-title":"Hypothyroxinemia and TPO-antibody positivity are risk factors for premature delivery: the generation R study","volume":"98","author":"Korevaar","year":"2013","journal-title":"J Clin Endocrinol Metab."},{"issue":"2","key":"2021031913432129400_CIT0017","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/01.AOG.0000152345.99421.22","article-title":"Subclinical hypothyroidism and pregnancy outcomes","volume":"105","author":"Casey","year":"2005","journal-title":"Obstet Gynecol."},{"issue":"10","key":"2021031913432129400_CIT0018","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1089\/thy.2011.0087","article-title":"Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum","volume":"21","author":"Stagnaro-Green","year":"2011","journal-title":"Thyroid."},{"issue":"4","key":"2021031913432129400_CIT0019","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1089\/thy.2015.0418","article-title":"Subclinical hypothyroidism in pregnancy: a systematic review and meta-analysis","volume":"26","author":"Maraka","year":"2016","journal-title":"Thyroid."},{"issue":"7","key":"2021031913432129400_CIT0020","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1001\/jama.2019.10931","article-title":"Association of thyroid function test abnormalities and thyroid autoimmunity with preterm birth: a systematic review and meta-analysis","volume":"322","author":"Korevaar","year":"2019","journal-title":"JAMA."},{"issue":"1","key":"2021031913432129400_CIT0021","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1097\/AOG.0b013e3181788dd7","article-title":"Maternal thyroid hypofunction and pregnancy outcome","volume":"112","author":"Cleary-Goldman","year":"2008","journal-title":"Obstet Gynecol."},{"issue":"3","key":"2021031913432129400_CIT0022","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1210\/jc.2008-1520","article-title":"Perinatal outcome of children born to mothers with thyroid dysfunction or antibodies: a prospective population-based cohort study","volume":"94","author":"M\u00e4nnist\u00f6","year":"2009","journal-title":"J Clin Endocrinol Metab."},{"issue":"3","key":"2021031913432129400_CIT0023","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1210\/jc.2009-1904","article-title":"Thyroid dysfunction and autoantibodies during pregnancy as predictive factors of pregnancy complications and maternal morbidity in later life","volume":"95","author":"M\u00e4nnist\u00f6","year":"2010","journal-title":"J Clin Endocrinol Metab."},{"issue":"11","key":"2021031913432129400_CIT0024","doi-asserted-by":"crossref","first-page":"4325","DOI":"10.1210\/jc.2015-3074","article-title":"Maternal thyroid disease and preterm birth: systematic review and meta-analysis","volume":"100","author":"Sheehan","year":"2015","journal-title":"J Clin Endocrinol Metab."},{"issue":"4","key":"2021031913432129400_CIT0025","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1097\/01.AOG.0000462945.27539.93","article-title":"Practice Bulletin No. 148: thyroid disease in pregnancy","volume":"125","author":"American College of Obstetricians and Gynecologists","year":"2015","journal-title":"Obstet Gynecol."},{"issue":"3","key":"2021031913432129400_CIT0026","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.fertnstert.2015.05.028","article-title":"Subclinical hypothyroidism in the infertile female population: a guideline","volume":"104","author":"Practice Committee of the American Society for Reproductive Medicine","year":"2015","journal-title":"Fertil Steril"},{"issue":"8","key":"2021031913432129400_CIT0027","doi-asserted-by":"crossref","first-page":"2543","DOI":"10.1210\/jc.2011-2803","article-title":"Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline","volume":"97","author":"De Groot","year":"2012","journal-title":"J Clin Endocrinol Metab."},{"key":"2021031913432129400_CIT0028","article-title":"Associations between maternal thyroid function in pregnancy and obstetric and perinatal outcomes - Supplemental Table 1","author":"Lee","year":"2019","journal-title":"OpenBU Repos."},{"issue":"2","key":"2021031913432129400_CIT0029","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1089\/thy.2018.0475","article-title":"Differences in diagnostic criteria mask the true prevalence of thyroid disease in pregnancy: a systematic review and meta-analysis","volume":"29","author":"Dong","year":"2019","journal-title":"Thyroid."},{"issue":"9","key":"2021031913432129400_CIT0030","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1089\/thy.2010.0058","article-title":"Maternal thyroid function at 11 to 13 weeks of gestation and subsequent fetal death","volume":"20","author":"Ashoor","year":"2010","journal-title":"Thyroid."},{"issue":"4","key":"2021031913432129400_CIT0031","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1210\/jc.2009-2009","article-title":"Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy","volume":"95","author":"Negro","year":"2010","journal-title":"J Clin Endocrinol Metab."},{"key":"2021031913432129400_CIT0032","doi-asserted-by":"crossref","first-page":"i6865","DOI":"10.1136\/bmj.i6865","article-title":"Thyroid hormone treatment among pregnant women with subclinical hypothyroidism: US national assessment","volume":"356","author":"Maraka","year":"2017","journal-title":"BMJ."},{"issue":"3","key":"2021031913432129400_CIT0033","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1210\/jc.2017-01850","article-title":"Effects of levothyroxine on pregnant women with subclinical hypothyroidism, negative for thyroid peroxidase antibodies","volume":"103","author":"Nazarpour","year":"2018","journal-title":"J Clin Endocrinol Metab."},{"issue":"7","key":"2021031913432129400_CIT0034","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1089\/thy.2016.0014","article-title":"Effects of levothyroxine therapy on pregnancy outcomes in women with subclinical hypothyroidism","volume":"26","author":"Maraka","year":"2016","journal-title":"Thyroid."},{"issue":"4","key":"2021031913432129400_CIT0035","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1159\/000343759","article-title":"Reduction of miscarriages through universal screening and treatment of thyroid autoimmune diseases","volume":"74","author":"Lepoutre","year":"2012","journal-title":"Gynecol Obstet Invest."},{"issue":"7","key":"2021031913432129400_CIT0036","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1210\/jc.2005-1603","article-title":"Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications","volume":"91","author":"Negro","year":"2006","journal-title":"J Clin Endocrinol Metab."},{"issue":"10","key":"2021031913432129400_CIT0037","doi-asserted-by":"crossref","first-page":"3685","DOI":"10.1210\/jc.2016-1803","article-title":"Impact of levothyroxine in miscarriage and preterm delivery rates in first trimester thyroid antibody-positive women with TSH less than 2.5 mIU\/L","volume":"101","author":"Negro","year":"2016","journal-title":"J Clin Endocrinol Metab."},{"issue":"9","key":"2021031913432129400_CIT0038","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1056\/NEJMoa1606205","article-title":"Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy","volume":"376","author":"Casey","year":"2017","journal-title":"N Engl J Med."},{"issue":"3","key":"2021031913432129400_CIT0039","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1210\/jc.2011-2038","article-title":"National status of testing for hypothyroidism during pregnancy and postpartum","volume":"97","author":"Blatt","year":"2012","journal-title":"J Clin Endocrinol Metab."},{"issue":"9","key":"2021031913432129400_CIT0040","doi-asserted-by":"crossref","first-page":"E1452","DOI":"10.1210\/jc.2011-0360","article-title":"Thyroid testing during pregnancy at an academic Boston Area Medical Center","volume":"96","author":"Chang","year":"2011","journal-title":"J Clin Endocrinol Metab."}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jcem\/advance-article-pdf\/doi\/10.1210\/clinem\/dgz275\/31532159\/dgz275.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jcem\/article-pdf\/105\/5\/e2015\/36645574\/dgz275.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jcem\/article-pdf\/105\/5\/e2015\/36645574\/dgz275.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T09:43:50Z","timestamp":1616147030000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/105\/5\/e2015\/5678077"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,15]]},"references-count":40,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2019,12,15]]},"published-print":{"date-parts":[[2020,5,1]]}},"URL":"https:\/\/doi.org\/10.1210\/clinem\/dgz275","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,5]]},"published":{"date-parts":[[2019,12,15]]}}}