Abnormal levels of thyroid hormones during pregnancy are associated with increased risk of complications such as anaemia, miscarriages, post-partum bleeding, pre-eclampsia and placental abruption
Thyroid disorders are highly prevalent in India. Approximately 8.3-10.4 per cent or one in ten adults suffer from hypothyroidism, which occurs when the thyroid gland does not produce enough thyroid hormones to meet the needs of the body. This condition is twice as prevalent in women as in men and the condition is common among women of child-bearing age. A 2016 study conducted in nine Indian states across OPD setups assessing prevalence of hypothyroidism in pregnancy with TSH cut-offs < 4.5 found 13.13 per cent of pregnant women to be hypothyroid. Following trimester-specific TSH cut-offs of <2.5 mIU/L for the first trimester and <3.0 mIU/L for the second and third trimester, as recommended by the FOGSI, ITS and NRHM guidelines, prevalence of hypothyroidism was found to be 44.3 per cent, 32.0 per cent, and 34 per cent in the first, second, and third trimester, respectively. There is significant regional variation in prevalence, and in Maharashtra, the study showed 17.85 per cent prevalence in Pune and 14 per cent in Nasik.
Abnormal levels of thyroid hormones during pregnancy are associated with increased risk of complications such as anaemia, miscarriages, post-partum bleeding, pre-eclampsia and placental abruption. The thyroid hormone is critical for normal development of the fetal brain and nervous system and during the first trimester, the fetus depends on the mother’s supply of thyroid hormone, which directly comes through the placenta. Therefore, treating thyroid disorders is important for both maternal and child health, as thyroid disorders significantly increase the risk of adverse birth outcomes such as preterm birth, low birth weight and fetal death. Thyroid hormone is critical for normal development of the fetal brain and nervous system.
Despite high prevalence of hypothyroidism among pregnant women in India, and the risks that the condition poses, there is low penetration of screening and testing for the condition in pregnant women. Dr Nandita Palshetkar, President of Federation of Obstetric and Gynaecological Societies of India (FOGSI), explains, “Since thyroid disorders present non-specific symptoms such as fatigue, weight gain, constipation etc., they are often difficult to diagnose without testing. In the absence of visible signs and symptoms of thyroid disorders, combined with low patient awareness, thyroid testing tends to be overlooked.”
Detection in the first trimester is particularly important. ITS guidelines recommend that testing should be conducted at the first prenatal visit or at the time of confirmation of pregnancy, and that diagnosis should be based on trimester-specific TSH thresholds. Dr Shashank Joshi, Secretary, Indian Thyroid Society (ITS), observes, “Late detection not only increases the chance that surgical intervention is required, but it also leads to higher risk of irreversible damage caused by complications. Thus, ITS and FOGSI strongly advocate thyroid screening in the first trimester of pregnancy and in maintaining trimester specific TSH at the upper threshold of 2.5 mI/L in the first trimester and 3.0 mI/L in the second and third trimester for better maternal and fetal outcomes.”
Awareness plays a critical role in the fight against under-detection. Under its campaign, Making India Thyroid Aware (MITA) and in partnership with Abbott India, ITS seeks to drive awareness amongst doctors and patients for early diagnosis and treatment of thyroid disorders amongst women in the age group of 25 to 45 years. Through a range of initiatives driving education among doctors, making Indian women aware of thyroid disorders and facilitating early detection, MITA has reached over 50,000 doctors and 5.6 million patients nationwide since 2011. Recently, Abbott and ITS launched a digital campaign to procure pledges from doctors across India in support of MITA. In recognition of each pledge and to further diagnostic access for underprivileged women, Abbott will donate an equal number of free screening tests to an NGO. More than 8,500 doctor pledges have been received till date.
Dr Srirupa, Medical Director, Abbott adds, “Abbott is a thought leader in thyroid therapy and has been a knowledge and education partner to ITS to drive awareness of thyroid disorders in India. In the coming year, Abbott, ITS and FOGSI plan to educate another 20,000 physicians and gynaecologists, while also driving awareness among 10 million thyroid patients through digital, print and in-clinic initiatives. Combining the skills and resources of multiple stakeholders, this campaign can lead to greater awareness, strengthening of health services and eventually better disease control. With access to the physician and gynaecologists bodies to cascade changes swiftly, we can raise awareness through initiatives at scale, ensuring they reach both medical and patient communities.”
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Sethi B. Indian J Endocr Metab 2017;21:302-7
Paul W Ladenson, Hypothyroidism Lancet 2004; 363: 793–803
Goyal D. Thyroid Res Pract 2019;16:55-9; Romitti M et al. Endocr Connect. 2018 Nov; 7(11): 1158–1167.
Dhanwal et al. Indian J Endocr Metab 2016;20:387-90
Swathi N. Int J Pharm Pharm Sci. 2018;10(6):23-25, Shekhar S. J Med Sci Clin Res. 2018;6(4)
Sethi B. Indian J Endocr Metab 2017;21:302-7 and Dhanwal et al. Indian J Endocr Metab 2016;20:387-90
Dhanwal et al. Indian J Endocr Metab 2016;20:387-90
Guidelines for Management of Thyroid Dysfunction During Pregnancy
2019 ITS FOGSI guidelines