Objective

Evidence for the association between subclinical thyroid dysfunction before conception and its pregnancy outcomes is inconsistent. Thus, we evaluated the relationship between preconception thyroid-stimulating hormone (TSH) levels and adverse pregnancy outcomes.

Design

Retrospective cohort study.

Methods

A total of 50217 women without prior thyroid disease who became pregnant within 1 year after undertaking a routine TSH test in the Chongqing Municipality of China (2010−2016) were studied. Restricted cubic spline regression and logistic regression were used to estimate the association between preconception TSH levels and pregnancy outcomes. The main outcomes were individual and composite adverse pregnancy outcomes (CAPO) comprising pregnancy loss, small for gestational age, large for gestational age, and preterm birth.

Results

Incidence of CAPO was 24.19%. Increased preconception TSH level was positively associated with CAPO (OR/SD 1.04, 95% CI 1.01−1.07) when TSH was ≥ 2.1 mIU/L, positively associated with pregnancy loss (OR/SD 1.06, 95% CI 1.01−1.12) when TSH was <2.1 mIU/L, negatively and positively associated with preterm delivery when TSH levels were <1.3 mIU/L (OR/SD 0.90, 95% CI 0.83–0.97) and >3.0 mIU/L(OR/SD 1.08, 95% CI 1.00–1.17), respectively. Women with subclinical hypothyroidism before conception were at a higher risk for CAPO (aOR 1.12, 95% CI 1.04–1.22), while those with subclinical hyperthyroidism had a higher risk of preterm delivery (aOR 1.31, 95% CI 1.01–1.70).

Conclusions

Non-linear associations was indicated between preconception TSH levels and pregnancy outcomes. Subclinical thyroid dysfunction before conception was associated with an increased risk of adverse pregnancy outcomes.

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