Evaluation of the predictive role of thyroglobulin antibodies combined with thyroid peroxidase antibodies on adverse pregnancy outcomes during early pregnancy.

Objective: The objective of this study was to explore whether combined assessment of TgAb and TPOAb perform a higher predictive value to adverse pregnancy outcomes than isolated TPOAb during early pregnancy.

Methods: This was a retrospective study of 4678 pregnant women receiving prenatal care at Peking University First Hospital from October 2017 to August 2018. Demographic and clinical data, including thyroid hormone levels, were retrieved from electronic medical records. The general information and incidence of adverse pregnancy outcomes were compared between different subgroups of thyroid function and antibody status.

Results: In total, 2673 women were enrolled. 6.70% (179/2673) and 8.27% (221/2673) of the pregnant women were TPOAb positive and TgAb positive, respectively. The median thyroid-stimulating hormone (TSH) level was higher in the TPOAb or TgAb positive group than in the antibody-negative group [1.40 (0.96, 2.01) vs. 1.34 (0.86, 1.92), P = 0.045]. The prevalence of maternal composite outcomes (66.08% vs. 58.90%, p = 0.09) and fetal loss (10.49% vs. 5.78%, P = 0.02) was greater among women with 2.5 < TSH ≤ 4.08 mIU/L than among those with 0.23 < TSH ≤ 2.5 mIU/L. When the TSH concentration ranged from 0.23 to 2.5 mIU/L, the prevalence of fetal loss was greater in the TPOAb or TgAb positive group than in the antibody-negative group (8.33% vs. 5.43%, P = 0.04). Compared with TPOAb measruement alone, the predictive value of the TPOAb and TgAb combined assessment for maternal (AUC values: 0.509, 95% CI = 0.485 ~ 0.532) and fetal (AUC values: 0.512, 95% CI = 0.458 ~ 0.565) adverse outcomes was not higher.

Conclusion: Under current treatment recommendations, the combined assessment of TPOAb and TgAb during pregnancy has limited predictive value for maternal-fetal adverse outcomes among euthyroid women compared with isolated TPOAb.