The interaction of risk factors for early pregnancy loss in conditions of natural iodine deficiency
DOI:
https://doi.org/10.15574/PP.2019.80.4Keywords:
early pregnancy loss, iodine deficiency, prediction algorithmAbstract
A methodology for assessing the prognostic value of various risk factors for early pregnancy loss (EPL) in women with altered parameters of iodine-thyroid homeostasis (ITH), permanently living in an endemic zone is presented.Purpose — to determine the prognostic value of EPL risk factors and to study their interaction in early spontaneous abortion in women with ITH disorders.
Patients and methods. The study involved 77 women living in conditions of natural iodine deficiency (47 women with spontaneous abortion in the first trimester and 30 women with full-term pregnancy). High informational content was established for 9 clinical and laboratory parameters, of which 4 (ioduria, TSH, the level of free thyroxine and the titer of TPO-ab) characterized the condition of EPL. By applying Wald's sequential analysis with an assessment of the information content of signs, a logistic model to predict the EPL is constructed.
Results. The altered parameters of ITH due to both iodine deficiency and the autoimmune component are associated with an increase in the incidence of EPL. Their independent prognostic value is realized only at an iodine excretion level <49 μg/L. Accordingly, at ioduria levels corresponding to a mild degree of iodine deficiency, or the absence thereof, the independent prognostic value of ITH parameters is not statistically significant and is realized only in combination with other risk factors. This necessitates a comprehensive pre-conceptual study of ITH parameters in assessing the risk of EPL in order to achieve an euthyroid condition by the time of pregnancy. A method for differentiated assessment EPL risk both with regard to the role of individual factors and their influence in the aggregate, namely the interaction of thyroid and nonthyroid risk factors.
Conclusions. The presented logistic model and the methodology for its interpretation showed the high significance of ITH parameters for predicting the risk of EPL.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of SU «Uzhhorod National University». The informed consent of the patient was obtained for conducting the studies.
No conflict of interest were declared by the authors. No conflict of interest were declared by the authors.
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