Orhan GELİŞEN, Deniz KARCAALTINCABA, Hatice KÖŞGER, İkbal KAYGUSUZ

The Effect of the Presence of Mother's Thyroid Autoantibodies on Intrauterine Fetal Death

Amaç: Annenin tiroid otoantikor pozitifliğinin intrauterin fetal ölüm üzerine etkisinin araştırılması Gereç ve Yöntemler: Çalışmaya 18-40 yaş arası 6-12. gebelik haftalarında 200 gebe dâhil edildi. En az bir kez 13 hafta ve üzeri intrauterin ölü fetus tanısıyla gebelik sonlandırması uygulanan hastalarla (çalışma grubu, n=100), en az 2 canlı doğumu olan ve ikinci trimester gebelik kaybı olmayan hastaların (kontrol grubu n=100) tiroid otoantikor titreleri ve antifosfolipid antikor titreleri karşılaştırıldı. Bulgular: İki grup arasında yaş, gebelik sayısı, düşük sayısı açısından istatistiksel anlamlı fark saptanmadı (p > 0.05). Anti-tiroid peroksidaz serum düzeyleri ortalaması çalışma grubunda kontrol grubuna göre anlamlı yüksek bulunmuştur (p = 0.009). Anti-tiroglobulin ve antikardiyolipin IgG düzey ortalamaları karşılaştırıldığında iki grup arasında fark bulunmamıştır (p > 0.05). Kontrol grubunda anti - tiroid peroksidaz pozitif gebe sayısı %3 iken, çalışma grubunda %11 olup, bu farklılık istatistiksel olarak yüksek bulunmuştur (p = 0.027). İki grup arasında anti-tiroglobulin, antikardiyolipin Ig-G ve lupus antikoagulan pozitifliği açısından istatistiksel anlamlı fark bulunmamıştır (p > 0.05). Tiroid otoantikor pozitifliği ile antifosfolipid antikor pozitifliği arasında zayıf korelasyon saptanmıştır. Sonuç: Tiroid otoantikorları gebelik kayıplarından sorumlu otoimmün faktörlerden biri olabilirler. Bu etkilerini direkt fetoplasental üniteyi etkileyerek veya tiroid fonksiyonlarını hafif derecede bozarak ve ya annenin immün sisteminde dengesizlik yaratarak yapabilirler. Ancak tiroid otoantikorlarının gebelik kayıplarındaki rolü ve patogenezi çok açık olmayıp geniş çapta çalışmalara ihtiyaç vardır.

Annenin Tiroid Otoantikor Pozitifliğinin İntrauterin Fetal Ölüm Üzerine Etkisi

Aim: The aim of this study is to evaluate on the effects of mother s thyroid autoantibodies on intrauterin fetal death. Meterial and Methods: A total of 200 pregnant women aged between 18 and 40 in their 6th-12th weeks of pregnancy were included in this study. The first group (study group) included 100 pregnant women who had previously experienced pregnancy loss in the second trimester in their previous pregnancies (termination of the pregnancy in the 13th-28th gestational weeks due to intrauterine fetal death). The second group (control group) also had 100 patients. Results: There is no statistically significant difference between the two groups in terms of age, number of pregnancies, and miscarriages (p>0.05). The avarage serum level of anti-thyroid peroxidase in the study group was higher than the control group (p=0.009). But when anti-thyroglobulin and anticardiolipin IgG levels were evaluated, we have seen that there was no difference between the two groups (p>0.05). Moreover, the ratio of pregnant women who had positive anti-thyroid peroxidase was %3 in the control group and %11 in the study group. This was considered statistically high (p=0.027). The correlation between the presence of thyroid autoantibodies and antiphospholipid antibody positivity was statistically low. Conclusion: Thyroid autoantibodies can be one of the autoimmune factors that are responsible for pregnancy loss. They show their effects by making a direct impact on the fetoplasental unit, causing thyroid malfunction, or creating an imbalance in the immune system of the mother. However, the role of thyroid autoantibodies on pregnancy losses are not clear and controlled studies are needed.

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