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Meta-Analysis
. 2023 Nov;40(11):2523-2537.
doi: 10.1007/s10815-023-02933-6. Epub 2023 Sep 29.

Thyroid autoimmunity and future pregnancy outcome in women of recurrent pregnancy loss: a meta-analysis

Xiaozhen Quan  1 , Yanli Lan  1 , Xuezhou Yang  2
Affiliations
Meta-Analysis

Thyroid autoimmunity and future pregnancy outcome in women of recurrent pregnancy loss: a meta-analysis

Xiaozhen Quan et al. J Assist Reprod Genet. 2023 Nov.

Abstract

Background: Thyroid autoimmunity (TAI) has been associated with the risk of recurrent pregnancy loss (RPL). This systematic review and meta-analysis was conducted to evaluate the influence of TAI on subsequent pregnancy outcome of women with RPL.

Methods: A systematic search of Medline, Web of Science, and Embase was conducted to identify studies evaluating the influence of TAI on subsequent risk of pregnancy loss (PL) in women with RPL. Study quality was evaluated via the Newcastle-Ottawa Scale. A random-effects model was utilized to pool the results, accounting for heterogeneity.

Results: Ten observational studies were included. Compared to women without thyroid autoantibodies, RPL women with TAI had a higher risk of PL in their subsequent pregnancy (risk ratio [RR]: 1.46. 95% confidence interval [CI]: 1.20 to 1.78, p < 0.001; I2 = 35%). Sensitivity analyses showed consistent results in studies with thyroid peroxidase antibody positivity (RR: 1.50, 95% CI: 1.23 to 1.82) and in studies with TAI assessed before pregnancy (RR: 1.28, 95% CI: 1.07 to 1.53). Subgroup analyses showed that the results were not significantly different in prospective and retrospective studies, in RPL defined as at least two or three PL, in euthyroid women and women with euthyroidism or subclinical hypothyroidism, in women with and without levothyroxine treatment, in studies reporting first-trimester or overall PL, and in studies with different quality scores (p for subgroup difference all > 0.05).

Conclusions: In women with RPL, positive for TAI may be related to a higher risk of PL in subsequent pregnancy.

Keywords: Levothyroxine; Meta-analysis; Recurrent pregnancy loss; Thyroid autoimmunity; Thyroid peroxidase antibody.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The diagram depicts the methodology of database exploration and study identification
Fig. 2
Fig. 2
Forest plots utilized to indicate the association between TAI and the risk of PL in subsequent pregnancy of women with RPL; A forest plots for the overall meta-analysis; B forest plots for the sensitivity analysis limited to TAI defined as positive for TPO-Ab; and C forest plots for the sensitivity analysis limited to studies with TAI assessed before subsequent pregnancy
Fig. 3
Fig. 3
Forest plots utilized to indicate the subgroup analysis of the association between TAI and the risk of PL in subsequent pregnancy of women with RPL; A subgroup analysis according to study design and B subgroup analysis according to definition of RPL
Fig. 4
Fig. 4
Forest plots utilized to indicate the subgroup analysis of the association between TAI and the risk of PL in subsequent pregnancy of women with RPL; A subgroup analysis according to thyroid function and B subgroup analysis according to levothyroxine treatment
Fig. 5
Fig. 5
Forest plots utilized to indicate the subgroup analysis of the association between TAI and the risk of PL in subsequent pregnancy of women with RPL; A subgroup analysis according to definition of PL in subsequent pregnancy and B subgroup analysis according to study quality scores
Fig. 6
Fig. 6
Funnel plots utilized to indicate the possible publication bias of the meta-analysis for the association between TAI and the risk of PL in subsequent pregnancy of women with RPL
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References

    1. Quenby S, Gallos ID, Dhillon-Smith RK, Podesek M, Stephenson MD, Fisher J, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet. 2021;397(10285):1658–1667. doi: 10.1016/S0140-6736(21)00682-6. - DOI - PubMed
    1. Dimitriadis E, Menkhorst E, Saito S, Kutteh WH, Brosens JJ. Recurrent pregnancy loss. Nat Rev Dis Primers. 2020;6(1):98. doi: 10.1038/s41572-020-00228-z10.1038/s41572-020-00228-z[pii]. - DOI - PubMed
    1. Amrane S, McConnell R. Endocrine causes of recurrent pregnancy loss. Semin Perinatol. 2019;43(2):80–83. doi: 10.1053/j.semperi.2018.12.004. - DOI - PubMed
    1. Deshmukh H, Way SS. Immunological basis for recurrent fetal loss and pregnancy complications. Annu Rev Pathol. 2019;14:185–210. doi: 10.1146/annurev-pathmechdis-012418-012743. - DOI - PMC - PubMed
    1. Pirtea P, Cicinelli E, De Nola R, de Ziegler D, Ayoubi JM. Endometrial causes of recurrent pregnancy losses: endometriosis, adenomyosis, and chronic endometritis. Fertil Steril. 2021;115(3):546–560. doi: 10.1016/j.fertnstert.2020.12.010. - DOI - PubMed

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