Levothyroxine in euthyroid pregnant women with thyroid peroxidase antibody: a systematic review and meta-analysis of randomized controlled trials.

IF 1.4

Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia Pub Date : 2025-11-18 eCollection Date: 2025-01-01 DOI:10.61622/rbgo/2025rbgo75

Henrique Provinciatto, Maria Esther Barbalho, Pedro Matos da Câmara, Marina Simão Bertani, Alice Deberaldini Marinho, Chris Elizabeth Philip, Caroline Cristine Almeida Balieiro, Karina Felippe Monezi Pontes, Edward Araujo Júnior

{"title":"Levothyroxine in euthyroid pregnant women with thyroid peroxidase antibody: a systematic review and meta-analysis of randomized controlled trials.","authors":"Henrique Provinciatto, Maria Esther Barbalho, Pedro Matos da Câmara, Marina Simão Bertani, Alice Deberaldini Marinho, Chris Elizabeth Philip, Caroline Cristine Almeida Balieiro, Karina Felippe Monezi Pontes, Edward Araujo Júnior","doi":"10.61622/rbgo/2025rbgo75","DOIUrl":null,"url":null,"abstract":"Objective: Thyroid peroxidase antibody (TPOAb) is a prevalent condition amongst women of reproductive age and has been associated with adverse pregnancy outcomes. However, there is currently no proven treatment for euthyroid pregnant women with TPOAb. Therefore, we aimed to investigate the efficacy of levothyroxine treatment in this population.Methods: We searched PubMed, Embase and Cochrane Central from inception to or randomized controlled trials (RCTs) comparing levothyroxine with placebo or no treatment in euthyroid pregnant women who were positive for TPOAb. Our main outcomes were miscarriage, preterm birth, and live birth. We performed subgroup analysis based on recurrent pregnancy loss (RPL).Results: We included 8 RCTs comprising 1,645 pregnant women, of whom 814 (49.5%) were randomized to receive levothyroxine. Pregnant women treated with levothyroxine had significantly lower miscarriages (RR 0.78; 95% CI 0.63-0.98; p=0.035). No significant difference was found regarding pre-term birth (RR 0.78; 95% CI 0.55-1.13; p=0.189) and live birth (RR 1.05; 95% CI 0.99-1.12; p=0.097). Our subgroup analysis demonstrated a significant interaction (p=0.048) between patients with RPL (RR 1.21; 95% CI 1.03-1.42; p=0.023) and no RPL (RR 1.00; 95% CI 0.92-1.09; p=0.922).Conclusion: Levothyroxine reduced miscarriage in pregnant women with TPOAb and improved live birth rate when associated with RPL. Our subgroup analysis also provides evidence that levothyroxine may have a higher benefit for patients with a history of RPL.Prospero registry: CRD42023410433.","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"47 ","pages":""},"PeriodicalIF":1.4000,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671679/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.61622/rbgo/2025rbgo75","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Objective: Thyroid peroxidase antibody (TPOAb) is a prevalent condition amongst women of reproductive age and has been associated with adverse pregnancy outcomes. However, there is currently no proven treatment for euthyroid pregnant women with TPOAb. Therefore, we aimed to investigate the efficacy of levothyroxine treatment in this population.

Methods: We searched PubMed, Embase and Cochrane Central from inception to or randomized controlled trials (RCTs) comparing levothyroxine with placebo or no treatment in euthyroid pregnant women who were positive for TPOAb. Our main outcomes were miscarriage, preterm birth, and live birth. We performed subgroup analysis based on recurrent pregnancy loss (RPL).

Results: We included 8 RCTs comprising 1,645 pregnant women, of whom 814 (49.5%) were randomized to receive levothyroxine. Pregnant women treated with levothyroxine had significantly lower miscarriages (RR 0.78; 95% CI 0.63-0.98; p=0.035). No significant difference was found regarding pre-term birth (RR 0.78; 95% CI 0.55-1.13; p=0.189) and live birth (RR 1.05; 95% CI 0.99-1.12; p=0.097). Our subgroup analysis demonstrated a significant interaction (p=0.048) between patients with RPL (RR 1.21; 95% CI 1.03-1.42; p=0.023) and no RPL (RR 1.00; 95% CI 0.92-1.09; p=0.922).

Conclusion: Levothyroxine reduced miscarriage in pregnant women with TPOAb and improved live birth rate when associated with RPL. Our subgroup analysis also provides evidence that levothyroxine may have a higher benefit for patients with a history of RPL.

Prospero registry: CRD42023410433.

Abstract Image

查看原文本刊更多论文

左旋甲状腺素对甲状腺过氧化物酶抗体孕妇的作用：随机对照试验的系统评价和荟萃分析。

目的：甲状腺过氧化物酶抗体（TPOAb）是育龄妇女的一种普遍疾病，与不良妊娠结局有关。然而，目前还没有证实治疗甲状腺功能正常的TPOAb孕妇。因此，我们的目的是调查左甲状腺素治疗在这一人群中的疗效。方法：我们检索了PubMed， Embase和Cochrane Central，从一开始到随机对照试验（rct），比较左旋甲状腺素与安慰剂或未治疗的TPOAb阳性甲状腺功能正常的孕妇。我们的主要结局是流产、早产和活产。我们进行了基于复发性妊娠丢失（RPL）的亚组分析。结果：我们纳入了8项随机对照试验，包括1,645名孕妇，其中814名（49.5%）随机接受左甲状腺素治疗。接受左甲状腺素治疗的孕妇流产率显著降低（RR 0.78; 95% CI 0.63-0.98; p=0.035）。早产（RR 0.78; 95% CI 0.55-1.13; p=0.189）和活产（RR 1.05; 95% CI 0.99-1.12; p=0.097）无显著差异。我们的亚组分析显示，RPL患者（RR 1.21; 95% CI 1.03-1.42; p=0.023）和无RPL患者（RR 1.00; 95% CI 0.92-1.09; p=0.922）之间存在显著的相互作用（p=0.048）。结论：左旋甲状腺素可减少TPOAb孕妇的流产，并可提高与RPL相关的活产率。我们的亚组分析也提供了证据，表明左旋甲状腺素可能对有RPL病史的患者有更高的益处。普洛斯彼罗注册表：CRD42023410433。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia

自引率

0.00%

发文量