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Detection of At-Risk Pregnancy by Means of Highly Sensitive Assays for Thyroid Autoantibodies

Detection of At-Risk Pregnancy by Means of Highly Sensitive Assays for Thyroid Autoantibodies Abstract We screened 552 women who presented to their obstetrician in the first trimester of pregnancy using highly sensitive enzyme-linked immunosorbent assays for the presence of thyroglobulin and thyroidperoxidase autoantibodies and found an incidence of positivity of 19.6%. The tendency to secrete detectable levels of thyroid autoantibodies was significantly correlated with an increased rate of miscarriage. Thyroid autoantibody—positive women miscarried at a rate of 17%, compared with 8.4% for the autoantibody-negative women. Individual levels of thyroglobulin and thyroidperoxidase autoantibodies were similarly related to this increased miscarriage rate, with no evidence of autoantibody specificity in the relationship. Furthermore, the increase in miscarriages could not be explained by differences in thyroid hormone levels, the presence of cardiolipin autoantibodies, maternal age, gestational age at the time of maternal entry into the study, or previous obstetric history. We conclude that thyroid autoantibodies are an independent marker of "at-risk" pregnancy. (JAMA. 1990;264:1422-1425) References 1. Whittaker PG, Taylor A, Lind T. Unsuspected pregnancy loss in healthy women . Lancet. 1983; 1:1126-1127.Crossref 2. Miller JF, Williamson E, Glue J, Gordon YB, Grudzinskas JG, Sykes A. Fetal loss after implantation: a prospective study . Lancet. 1980;2:554-556.Crossref 3. Edmonds DK, Lindsay KS, Miller JF, Williamson E, Wood PJ. Early embryonic mortality in women . Fertil Steril. 1982;4:447-453. 4. Wilcox AJ, Weinberg CR, O'Connor JF, et al. Incidence of early loss of pregnancy . N Engl J Med. 1988;319:189-194.Crossref 5. Stray-Pederson B, Stray-Pederson S. Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion . Am J Obstet Gynecol. 1984;148:140-146. 6. Scott JR, Rote NS, Branch DW. Immunologic aspects of recurrent abortion and fetal death . Obstet Gynecol. 1987;70:654-656. 7. Branch DW, Scott JR, Kochenour NK, Hershgold E. Obstetric complications associated with the lupus anticoagulant . N Engl J Med. 1985;313:1322-1326.Crossref 8. Cowchock S, Dehoratius RD, Wapner RJ, Jackson LG. Subclinical autoimmune disease and unexplained abortion . Obstetrics. 1984;150:367-371. 9. Maier DB, Parke A. Subclinical autoimmunity in recurrent aborters . Fertil Steril. 1989;51:280-285. 10. Davies TF, Weiss I. Autoimmune thyroid disease and pregnancy . Am J Reprod Immunol. 1981; 1:187-192.Crossref 11. Davies TF, Cobin R. Thyroid disease in pregnancy and the postpartum period . In: Cherry HS, Berkowitz RL, Kase NG, eds. Medical, Surgical and Gynecological Complications of Pregnancy . 3rd ed. Baltimore, Md: Williams & Wilkins; 1985:390-407. 12. Roman SH, Korn F, Davies TF. Enzyme-linked immunosorbent microassay and hemagglutination compared for detection of thyroglobulin and thyroid microsomal autoantibodies . Clin Chem. 1984; 30:246-251. 13. Davies TF, Weber CM, Wallack P, Platzer M. Restricted heterogeneity and T cell dependence of human thyroid autoantibody immunoglobulin G subclasses . J Clin Endocrinol Metab. 1986;62:945-949.Crossref 14. Loizou S, McCrea JD, Rudge AC, Reynolds R, Boyle CC, Harris EN. Measurement of anti-cardiolipin antibodies by an enzyme-linked immunosorbent assay (ELISA): standardization and quantitation of results . Clin Exp Immunol. 1985;62:738-745. 15. Vargas MT, Briones-Urbina R, Gladman D, Papsin FR, Walfish PG. Antithyroid microsomal autoantibodies and HLA-DR5 are associated with post-partum thyroid dysfunction: evidence supporting an autoimmune pathogenesis . J Clin Endocrinol Metab. 1988;67:327-333.Crossref 16. Jansson R, Bernander S, Karlsson A, Levin K, Nilsson G. Autoimmune thyroid dysfunction in the postpartum period . J Clin Endocrinol Metab. 1984;58:681-687.Crossref 17. Beever K, Bradbury J, Philips D, et al. Highly sensitive assays of autoantibodies to thyroglobulin and to thyroid peroxidase . Clin Chem. 1989;35: 1949-1954. 18. Roman SH, Davies TF, Witt ME, Ginsberg-Fellner F, Rubinstein P. Thyroid autoantibodies in HLA-genotyped type I diabetic families: sex-limited DR5 association with microsomal antibody . Clin Endocrinol. 1986;25:23-33.Crossref 19. Kendler DL, Martin A, Magnusson RP, Davies TF. Utilization of recombinant human antigen in the detection of autoantibodies to thyroid peroxidase by enzyme immunoassay . Clin Endocrinol. In press. 20. Yoshida H, Amino A, Yagawa K, et al. Association of serum antithyroid antibodies with lymphocytic infiltration of the thyroid gland: studies of seventy autopsied cases . J Clin Endocrinol Metab. 1978;46:859-862.Crossref 21. Litaenberg JC, Carey JB. The relation of basal metabolism to gestation . Am J Obstet Gynecol. 1929;17:550-522. 22. Lum J, Man EB. Serum butanol-extractable iodiones in abortions . Yale JBiol Med. 1955;28:105-120. 23. Montoro M, Collea JV, Frasier SD, Mestman JH. Successful outcome of pregnancy in women with hypothyroidism . Ann Intern Med. 1981;94:31-34.Crossref 24. Firkin BG, Howard MA, Radford N. Possible relationship between lupus inhibitor and recurrent abortion in young women . Lancet. 1980;2:360-366. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Detection of At-Risk Pregnancy by Means of Highly Sensitive Assays for Thyroid Autoantibodies

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Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.1990.03450110068029
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Abstract

Abstract We screened 552 women who presented to their obstetrician in the first trimester of pregnancy using highly sensitive enzyme-linked immunosorbent assays for the presence of thyroglobulin and thyroidperoxidase autoantibodies and found an incidence of positivity of 19.6%. The tendency to secrete detectable levels of thyroid autoantibodies was significantly correlated with an increased rate of miscarriage. Thyroid autoantibody—positive women miscarried at a rate of 17%, compared with 8.4% for the autoantibody-negative women. Individual levels of thyroglobulin and thyroidperoxidase autoantibodies were similarly related to this increased miscarriage rate, with no evidence of autoantibody specificity in the relationship. Furthermore, the increase in miscarriages could not be explained by differences in thyroid hormone levels, the presence of cardiolipin autoantibodies, maternal age, gestational age at the time of maternal entry into the study, or previous obstetric history. We conclude that thyroid autoantibodies are an independent marker of "at-risk" pregnancy. (JAMA. 1990;264:1422-1425) References 1. Whittaker PG, Taylor A, Lind T. Unsuspected pregnancy loss in healthy women . Lancet. 1983; 1:1126-1127.Crossref 2. Miller JF, Williamson E, Glue J, Gordon YB, Grudzinskas JG, Sykes A. Fetal loss after implantation: a prospective study . Lancet. 1980;2:554-556.Crossref 3. Edmonds DK, Lindsay KS, Miller JF, Williamson E, Wood PJ. Early embryonic mortality in women . Fertil Steril. 1982;4:447-453. 4. Wilcox AJ, Weinberg CR, O'Connor JF, et al. Incidence of early loss of pregnancy . N Engl J Med. 1988;319:189-194.Crossref 5. Stray-Pederson B, Stray-Pederson S. Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion . Am J Obstet Gynecol. 1984;148:140-146. 6. Scott JR, Rote NS, Branch DW. Immunologic aspects of recurrent abortion and fetal death . Obstet Gynecol. 1987;70:654-656. 7. Branch DW, Scott JR, Kochenour NK, Hershgold E. Obstetric complications associated with the lupus anticoagulant . N Engl J Med. 1985;313:1322-1326.Crossref 8. Cowchock S, Dehoratius RD, Wapner RJ, Jackson LG. Subclinical autoimmune disease and unexplained abortion . Obstetrics. 1984;150:367-371. 9. Maier DB, Parke A. Subclinical autoimmunity in recurrent aborters . Fertil Steril. 1989;51:280-285. 10. Davies TF, Weiss I. Autoimmune thyroid disease and pregnancy . Am J Reprod Immunol. 1981; 1:187-192.Crossref 11. Davies TF, Cobin R. Thyroid disease in pregnancy and the postpartum period . In: Cherry HS, Berkowitz RL, Kase NG, eds. Medical, Surgical and Gynecological Complications of Pregnancy . 3rd ed. Baltimore, Md: Williams & Wilkins; 1985:390-407. 12. Roman SH, Korn F, Davies TF. Enzyme-linked immunosorbent microassay and hemagglutination compared for detection of thyroglobulin and thyroid microsomal autoantibodies . Clin Chem. 1984; 30:246-251. 13. Davies TF, Weber CM, Wallack P, Platzer M. Restricted heterogeneity and T cell dependence of human thyroid autoantibody immunoglobulin G subclasses . J Clin Endocrinol Metab. 1986;62:945-949.Crossref 14. Loizou S, McCrea JD, Rudge AC, Reynolds R, Boyle CC, Harris EN. Measurement of anti-cardiolipin antibodies by an enzyme-linked immunosorbent assay (ELISA): standardization and quantitation of results . Clin Exp Immunol. 1985;62:738-745. 15. Vargas MT, Briones-Urbina R, Gladman D, Papsin FR, Walfish PG. Antithyroid microsomal autoantibodies and HLA-DR5 are associated with post-partum thyroid dysfunction: evidence supporting an autoimmune pathogenesis . J Clin Endocrinol Metab. 1988;67:327-333.Crossref 16. Jansson R, Bernander S, Karlsson A, Levin K, Nilsson G. Autoimmune thyroid dysfunction in the postpartum period . J Clin Endocrinol Metab. 1984;58:681-687.Crossref 17. Beever K, Bradbury J, Philips D, et al. Highly sensitive assays of autoantibodies to thyroglobulin and to thyroid peroxidase . Clin Chem. 1989;35: 1949-1954. 18. Roman SH, Davies TF, Witt ME, Ginsberg-Fellner F, Rubinstein P. Thyroid autoantibodies in HLA-genotyped type I diabetic families: sex-limited DR5 association with microsomal antibody . Clin Endocrinol. 1986;25:23-33.Crossref 19. Kendler DL, Martin A, Magnusson RP, Davies TF. Utilization of recombinant human antigen in the detection of autoantibodies to thyroid peroxidase by enzyme immunoassay . Clin Endocrinol. In press. 20. Yoshida H, Amino A, Yagawa K, et al. Association of serum antithyroid antibodies with lymphocytic infiltration of the thyroid gland: studies of seventy autopsied cases . J Clin Endocrinol Metab. 1978;46:859-862.Crossref 21. Litaenberg JC, Carey JB. The relation of basal metabolism to gestation . Am J Obstet Gynecol. 1929;17:550-522. 22. Lum J, Man EB. Serum butanol-extractable iodiones in abortions . Yale JBiol Med. 1955;28:105-120. 23. Montoro M, Collea JV, Frasier SD, Mestman JH. Successful outcome of pregnancy in women with hypothyroidism . Ann Intern Med. 1981;94:31-34.Crossref 24. Firkin BG, Howard MA, Radford N. Possible relationship between lupus inhibitor and recurrent abortion in young women . Lancet. 1980;2:360-366.

Journal

JAMAAmerican Medical Association

Published: Sep 19, 1990

References