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Abstract(s)
Introdução: A disfunção tiroideia é frequente na gravidez e pensa-se que esta esteja associada a maus desfechos obstétricos e neonatais, uma vez que o normal funcionamento da glândula tiroide é fundamental para o desenvolvimento fetal. Embora o feto consiga sintetizar hormonas da tiroide, entre a décima e a décima segunda semana de gestação, ele é dependente das hormonas maternas até à vigésima semana. A patologia tiroideia que mais frequentemente afeta a gravidez é o hipotiroidismo subclínico. De forma inconsistente, esta patologia tem sido associada a aumento de abortamentos espontâneos e mortes fetais, descolamento prematuro da placenta e rutura de membranas, além de alterações no neurodesenvolvimento dos seus filhos.
Objetivos: O objetivo desta monografia foi verificar se existe evidência de melhorias nos desfechos obstétricos e neonatais do hipotiroidismo subclínico tratado durante a gravidez, bem como no desempenho cognitivo da criança, filha de mãe com esta patologia.
Material e Métodos: O presente trabalho teve como base a pesquisa bibliográfica de artigos científicos na base de dados “PubMed/MEDLINE” com recurso às palavras-chave “subclinical hypothyroidism”, “pregnancy” e “treatment”. A pesquisa incluiu ensaios clínicos, observacionais e retrospetivos. A pesquisa foi completada através da consulta de documentos de entidades científicas.
Resultados: Esta monografia identificou nove artigos que abordaram os efeitos do tratamento nos desfechos adversos do hipotiroidismo subclínico na gravidez, bem como no neurodesenvolvimento dos filhos de mães com esta patologia. A globalidade dos estudos não identificou diferenças na anemia materna, hemorragia pós-parto, rutura de membranas, descolamento prematuro da placenta nem no neurodesenvolvimento e comportamento da criança. Contudo, não existiu consenso, entre os diversos estudos referenciados, relativamente à taxa de trabalho de parto pré-termo, perda gestacional, diabetes e hipertensão gestacional, número de recém-nascidos com baixo peso à nascença e com baixos resultados APGAR.
Discussão: Os dados disponíveis, relativamente às vantagens e desvantagens do tratamento do hipotiroidismo subclínico na gravidez, permanecem, ainda, pouco conclusivos. Isto poderá dever-se, particularmente, às caraterísticas dos estudos que têm sido desenvolvidos, uma vez que são estudos com amostras pequenas e que carecem de uma metodologia e critérios rigorosos para a sua elaboração.
Conclusão: Este trabalho veio reforçar a necessidade da realização de mais estudos prospetivos, randomizados rigorosos neste tema. Estes deverão envolver uma amostra mais alargada de pacientes, de modo a que se possam tirar conclusões generalizáveis à população-geral.
Introduction: Thyroid dysfunction is frequent during pregnancy and it is thought to be associated with poor obstetric and neonatal outcomes. The normal functioning of the thyroid gland is fundamental for fetal development. Although the fetus can synthesize thyroid hormones between the tenth and twelfth week of gestation, it is dependent on maternal hormones up to the twentieth week. The thyroid pathology that most often affects pregnancy is subclinical hypothyroidism. In an inconsistent way, this pathology has been associated with an increase in spontaneous abortion rates and fetal death, placental abruption and premature rupture of membranes, in addition to, changes in the neurodevelopment of children born in such conditions. The aim of this study was to verify if the treatment of subclinical hypothyroidism was able to improve obstetric and neonatal outcomes in pregnancy as well as in children’s cognitive performance. Material and Methods: The present work was based on a bibliographic research of scientific articles in the database "PubMed / MEDLINE" with the use of the keywords "subclinical hypothyroidism", "pregnancy" and "treatment". The study included clinical trials and retrospective studies. The research was completed through the consultation of documents of scientific entities. Results: This monograph identifies 9 articles that address the effects of treatment on the adverse outcomes of subclinical hypothyroidism in pregnancy and on the neurodevelopment of their children. Overall, most of the studies did not identify differences in maternal anemia, postpartum bleeding loss, premature rupture of membranes, placental abruption, and in child’s neurodevelopment. However, there was no consensus among the several studies, concerning the rate of preterm labor, pregnancy loss, gestational diabetes and gestational hypertension, number of newborn children with low birth weight and low APGAR scores. Discussion: The available data on the advantages and disadvantages of treatment of subclinical hypothyroidism in pregnancy remains unclear. The lack of a methodology and strict criteria for the development of clinical trials and, additionally, the small sample size of the studies limits their results. Conclusion: This study demonstrates that this topic is not yet supported by adequate studies. There is a need for more rigorous randomized prospective studies on this topic. A broader sample of patients should be involved, so that generalizable conclusions can be drawn for the general population.
Introduction: Thyroid dysfunction is frequent during pregnancy and it is thought to be associated with poor obstetric and neonatal outcomes. The normal functioning of the thyroid gland is fundamental for fetal development. Although the fetus can synthesize thyroid hormones between the tenth and twelfth week of gestation, it is dependent on maternal hormones up to the twentieth week. The thyroid pathology that most often affects pregnancy is subclinical hypothyroidism. In an inconsistent way, this pathology has been associated with an increase in spontaneous abortion rates and fetal death, placental abruption and premature rupture of membranes, in addition to, changes in the neurodevelopment of children born in such conditions. The aim of this study was to verify if the treatment of subclinical hypothyroidism was able to improve obstetric and neonatal outcomes in pregnancy as well as in children’s cognitive performance. Material and Methods: The present work was based on a bibliographic research of scientific articles in the database "PubMed / MEDLINE" with the use of the keywords "subclinical hypothyroidism", "pregnancy" and "treatment". The study included clinical trials and retrospective studies. The research was completed through the consultation of documents of scientific entities. Results: This monograph identifies 9 articles that address the effects of treatment on the adverse outcomes of subclinical hypothyroidism in pregnancy and on the neurodevelopment of their children. Overall, most of the studies did not identify differences in maternal anemia, postpartum bleeding loss, premature rupture of membranes, placental abruption, and in child’s neurodevelopment. However, there was no consensus among the several studies, concerning the rate of preterm labor, pregnancy loss, gestational diabetes and gestational hypertension, number of newborn children with low birth weight and low APGAR scores. Discussion: The available data on the advantages and disadvantages of treatment of subclinical hypothyroidism in pregnancy remains unclear. The lack of a methodology and strict criteria for the development of clinical trials and, additionally, the small sample size of the studies limits their results. Conclusion: This study demonstrates that this topic is not yet supported by adequate studies. There is a need for more rigorous randomized prospective studies on this topic. A broader sample of patients should be involved, so that generalizable conclusions can be drawn for the general population.
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Keywords
Endocrinologia Gravidez Hipotiroidismo Subclínico Tratamento