Pregnancy is one of the crucial stages of a woman’s life which requires utmost care and importance. But when the pregnancy is compounded by endocrine disorders such as hypothyroidism, you need to be extremely careful due to the increased risk of complications to the mother and baby. Studies[1] have reported that women with hypothyroidism have decreased fertility. Moreover, even if they conceive, there is a high risk of abortion and gestational hypertension. It also ups the risk of anemia and postpartum hemorrhage. So in this article, we look at the wider range of implications, symptoms, and measures that need to be taken for hypothyroidism in women who plan to get pregnant.
What Causes Hypothyroidism During Pregnancy?
Hypothyroidism is a condition in which the thyroid gland produces less than normal amount of hormones. Many times women develop hypothyroidism during pregnancy. It is mainly because they start producing antibodies against the thyroid gland. If it is left untreated, it can result in a condition known as preeclampsia in which a woman’s blood pressure tends to rise significantly during the last 3 months of pregnancy. This can not only lead to premature delivery or miscarriage but can also affect the growth and development of the fetus.
Noteworthily, the incidence of hypothyroidism in pregnant women is high in a developing country like India but the rate of detection is very low[1]. While the disorder can be fatal if left untreated, it can easily be treated if timely diagnosed.
Thyroid hormones are essential for the development of your child’s nervous system and brain. It is through the placenta that the fetus receives thyroid hormone during the first trimester, i.e. first 3 months of pregnancy. The baby’s thyroid starts to function on its own around 12 weeks into the pregnancy[2]. However, it does not make sufficient amounts of the hormone until around 18 to 20 weeks of pregnancy.
Two pregnancy hormones namely estrogen and human chorionic gonadotropin (HCG) cause a greater amount of thyroid hormones to be released during pregnancy. The thyroid gland does enlarge slightly during pregnancy even in healthy women, but it is not sufficient for a medical health professional to feel during a medical exam. Hence, it is advised to look for symptoms and get screened for thyroid during pregnancy.
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Symptoms of Hypothyroidism During Pregnancy
The normal function of the thyroid gland it to regulate metabolism, muscle control and brain development, but when it produces less hormones than normal, it can lead to excessive fatigue, weight gain, hair loss, muscle weakness, feeling depressed, constipation and feeling cold. Symptoms of hypothyroidism are the same in a pregnant woman as it is to a regular person. These symptoms include:
Extreme Tiredness: Extreme tiredness is one of the common symptoms of hypothyroidism. You become tired even when you have not done much work. It is common for women to feel tired during pregnancy, but if you start feeling tired in a short time, then you should consult your doctor immediately.
Trouble Dealing with Cold: Many that suffer from the disorder report that they have more trouble dealing with cold.
Muscle Cramps: Muscle cramps are another symptom of hypothyroidism that many experiences. Cramps are normal during pregnancy which is why many pregnant women ignore cramps. However, if you start getting cramps regularly then consult immediately with you doctor.
Severe Constipation: Those suffering from the disorder experiences severe constipation. It is common to not experience bowel movement for days on end.
Problems with Memory: Many that suffer from this disorder experience problems while trying to recollect events. A dip in concentration levels is also witnessed in many women.
Why Thyroid Screening Is Important During Pregnancy?
Thyroid problems are harder to spot during pregnancy because there are many overlapping symptoms as well as vast changes in thyroid hormone levels. This is why, it is advisable to get a complete checkup before you plan to conceive. It will help you in knowing the factors that you need to be very cautious about before and during pregnancy.
Thyroid testing before pregnancy is a good idea. However, when it comes to pregnancy, there is a minor disagreement among experts. It is recommended that all antenatal women should undergo thyroid screening as early treatment can help regulate the level of thyroid hormones effectively[3]. Also, thyroid testing is prudent if certain factors are present. These include:
– Exposure to neck or head radiation
– Type 1 diabetes
– Morbid obesity
– History of thyroid disease in the family
– Iodine deficiency
– Issue related to infertility
– Multiple miscarriages
If the checkups reveal that you have hypothyroidism, you need not panic. Detection of the condition before conceiving is a good thing as the condition can be managed. Your doctor will prescribe medications and supplements to boost your iron, and calcium levels. It is crucial to remember that you should not ignore even normal effects of pregnancy if you have hypothyroidism. Always consult your doctor, endocrinologist and obstetrician.
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How Hypothyroidism Affects Mother And Baby?
Hypothyroidism, if left unchecked, can have long-lasting effects on the health of both the mother as well as the child. Hypothyroidism and pregnancy together can lead to multiple pregnancy complications. The following are the effects it can have:
– Congestive heart failure
– Stillbirth
– Low birth weight
– Miscarriages
– Anemia
– Preeclampsia
Measures You Should Take During Pregnancy
There are some measures and steps that will help you in managing hypothyroidism during pregnancy[4]:
– Consulting your doctors (endocrinologists and obstetricians) to ensure safe pregnancy
– Planning and managing your diet to control your weight and hormonal levels
– Regular monitoring of your thyroid hormone levels as and when suggested by the doctor
One of the primary issues that most of the women face is that many of the symptoms mentioned above are considered normal during pregnancy. However, if you feel that any of the symptoms appear for longer than they normally do during pregnancy, you should immediately consult your doctor.
To prevent or detect hypothyroidism at an earlier stage, it is ideal to undergo antepartum testing on a regular basis. The goal of such tests is to prevent fetal death and detect health threats, if any, by detection and treatment of the condition more effectively and on time.
(The article is reviewed by Dr. Swati Mishra, Medical Editor)
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References:
1. Sahay R, Nagesh V. Hypothyroidism in pregnancy. Indian Journal of Endocrinology and Metabolism. 2012;16(3).
2. Information H, Diseases E, Pregnancy T, Pregnancy T, Center T, Health N. Thyroid Disease & Pregnancy | NIDDK [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases. 2018 [cited 30 August 2018].
3. Prasad D, Nair N, K. D. A descriptive study of the prevalence of hypothyroidism among antenatal women and foetal outcome in treated hypothyroid women. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2016;:1892-1896.
4. Abalovich M, Amino N, Barbour LA, Cobin RH, De Groot LJ, Glinoer D, Mandel SJ, Stagnaro-Green A. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2007 Aug;92(8 Suppl):S1-47.