Thyroid Function as a Possible Cause
Professor Schleußner concludes with some degree of resignation in his CME article that currently no measures exist to reduce the preterm birth rate. In the context of medical therapeutic freedom new drugs could be used off-label in order to reduce prematurity; but, even more importantly, a pressing need exists for high-quality research in this area of obstetrics.
This is not entirely correct. My experiences over the past 12 years have shown that optimizing maternal thyroid function during pregnancy can substantially lower the rate of preterm birth in multiparous women with singleton pregnancies, to below 3% (versus 6.7% in the perinatal statistics for Baden–Württemberg in 2006).
Each pregnancy increases maternal thyroid function substantially. For the fetus, maternal free serum thyroxine (fT4) is of crucial importance as it promotes the development of the fetal brain. A maternal fT4 concentration in the high normal reference range is optimal. In the presence of iodine deficiency or thyroid antibodies, the thyroid produces primarily triiodothyronine (T3) and not the inactive pro-hormone thyroxine, in order to maintain maternal euthyroidism throughout the pregnancy. The resultant maternal hypothyroxinemia may impair the development of the fetal brain.
Hypothyroxinemia can be corrected by using L-thyroxine and iodide. This benefits the development of the fetal brain, and lowers the rate of preterm birth in multiparous women with singleton pregnancies drastically.
In 2010, the data were presented at the Congress of the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V., DGGG) in Munich and published in 2011 (www.ncbi.nlm.nih.gov/pubmed/22203918)
Since the 2010 publication, nothing much has changed in the rate of preterm birth in spite of an increase in the number of cases. Much evidence suggests a physiological association between maternal hypothyroxinemia and preterm birth. I am quite happy to provide the original data to Professor Schleußner for inspection.
Dr. med. Pompilio Torremante
Conflict of interest statement
Dr Torremante has received honoraria for preparing scientific advanced training events from Schering Bayer and Dr Pfleger. Furthermore, he has received author fees from Hexal.
|1.||Torremante P: Schilddrüse und Schwangerschaft Teil 1 und Teil 2. Frauenarzt 2002; 43: 1052–196.|
|2.||Torremante P: Potenzielle Gefährdung der fetalen Gehirnentwicklung bei Hypothyroxinämie der Mutter. GebFra 2005; 65: 212–4.|
|3.||Torremante P, Flock F, Kirschner W: Free thyroxine level in the high normal reference range prescribed for nonpregnant women may reduce the preterm delivery rate in multiparous. J Thyroid Res 2011; 2011: 905734. MEDLINE PubMed Central|
|4.||Schleußner E: The prevention, diagnosis and treatment of premature labor. Dtsch Arztebl Int 2013; 110(13): 227–36. VOLLTEXT|