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Journal of Drug Delivery and Therapeutics

Open Access to Pharmaceutical and Medical Research

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Open Access  Full Text Article                                                                                                                 Research Article

A Prospective Study on Thyroid Dysfunction and Hypertensive Disorder in Pregnant Women

Tadikonda Rama Rao *¹, Rayeni Srujana ², Jakkula Namratha ², Rabia Basri ²

¹ Department of Pharm D, CMR College of Pharmacy, Kandlakoya, Medchal, India

² Pharm D, CMR College of Pharmacy, Kandlakoya, Medchal, India

 

 

INTRODUCTION:

Raised blood pressure during maternity is a condition known as gestational hypertension (GH), which, if not treated effectively, can result in fatal consequences such pre-eclampsia, eclampsia, and mortality ¹. It is estimated that 10% to 17% of all pregnancies are impacted by hypertension, a multisystemic illness. The mechanisms underlying the pathogenesis of GH have not yet been fully elucidated, despite the fact that they play a significant role in maternal and perinatal morbidity and mortality. However, hypothyroidism can seriously disrupt the cardiovascular system by altering left ventricular function, lowering cardiac output, and increasing systemic vascular resistance. However, a number of things have been proposed as contributing mechanisms to the increase in blood pressure during pregnancy. These include up to 40% increase in total plasma volume and a 25% rise in red blood cell mass ².

Thyroid linked endocrinopathies are the second most prevalent endocrine illness in women overall, after diabetes mellitus. In individuals of reproductive age, these illnesses are 4-5 times more common, and they may also be more common in individuals with co-morbid illnesses such pregnancy hypertension ³. Studies have indicated that people with subclinical hypothyroidism have reduced endothelium-associated vasodilation, which raises the possibility that this condition increases the risk of hypertensive problems during pregnancy ⁴.

Levothyroxine administration during gestation is correlated to other comorbidities and a 1.5-times increased risk for preeclampsia ⁵. The most frequent instance of thyroid malfunction during gestation is an increase in TSH levels with normal FT3 and FT4 levels ⁶.

Tests presently in use to determine thyroid activity TSH, triiodothyronine (T3), and thyroxine (T4) are occasionally inadequate to definitively establish the illness because T3 and T4 levels are influenced by so many additional non-specific illnesses ⁷. Thus, this present study is aimed to assess the thyroid function and hypertension among pregnant women attending antenatal clinic at Gandhi hospital using TSH, FT3 and FT4, as markers.  

MATERIAL AND METHODS:

This is an observational prospective study conducted in the inpatient department of Gynecology at Gandhi hospital, Secunderabad from September 2022 to February 2023, with study duration of 6 months. The protocol has been approved by Institutional Ethics Committee at CMR College of pharmacy. The sample size is 120 and 101 cases have been collected. For documentation purposes, a systematic data collection was created in accordance with the standards, and cases were examined and gathered based on the inclusion and exclusion criteria. The sample size is 101 cases have been collected. The purpose of the study is to review patient information up until discharge, analyze medical data, and note any new problems that develop. The study will also gather data and assess the affected population. The final report will be generated after the analysis and interpretation of the data. The inclusion criteria are pregnant women with hypertension, hypothyroidism, both hypertension and hypothyroidism, and pregnant women. Dropout criteria include patients who abscond, die, or leave the hospital in between the treatment course. Data were obtained on various parameters and final data was analysed by using SPSS software version 29 to obtain the results.

RESULTS:

A total of 101 cases were collected during the study period of 6 months, out of these 101 cases, no patient has left or absconded. Finally 101 cases were identified and analysed for final outcome. 

Out of 101 cases, hypothyroidism has highest cases (47%) followed by hypertension (32%) and women with both hypertension and hypothyroidism are 21% (FIGURE 1).

 

FIGURE 1

One sample t-test, mean and standard deviation for age, gestational age and length of stay:

Statistical analysis was performed using SPSS software version 29, parameters were assessed using one sample t-test and p value was found to be <0.001 which shows that the taken parameters are statistically highly significant (TABLE 1)

TABLE 1: One sample t-test, mean and standard deviation for age, gestational age and length of stay:

Parameters	Test Subjects (Mean ± SD)	p-value
Age	(25.63±4.086)	<0.001
Gestational age (weeks)	(29.69±6.379)	<0.001
Length of stay	(7.78±2.700)	<0.001

 

CHI-SQUARE ANALYSIS:

Null hypothesis (H0): Hypertension and hypothyroidism are dependent.

Alternative hypothesis (H1): Hypertension and hypothyroidism are independent.

As the chi-square value is greater than the table value null hypothesis is rejected (TABLE 2).

 

 

TABLE 2: Correlation between hypothyroidism and hypertension in pregnant women:

		Women with hypothyroidism		Total	Percentage	Chi square
		No	Yes
Women with hypertension	No	0	48	48	47%	42.422
	Yes	32	21	53	53%
Total		32	69	101	100%

 

Test of significance by Pearson Chi-square test {χ²-test}:

χ²_cal=42.422 {at 95% confidence limit, with degree of freedom=1, χ²_tab=3.841}

χ²_cal >χ²_tab {42.422>3.841} at 5% level of significance. 

Hence, there was statistically significant difference between the hypertension and hypothyroidism in pregnant women.

Categorization of drugs: Category of drugs prescribed to the patient for the better outcome (TABLE 3) 

TABLE 3: Categorization of drugs:

Sl. No.	Category of drugs	No. of cases	Percentage
1	Multivitamins	93	92%
2	Antihypertensive	83	82%
3	Thyroid agents	59	58%
4	Antacid	51	50%
5	Antibiotic	28	28%
6	NSAIDS	8	8%
7	Female hormone	2	2%
8	Anti-fibrinolytic agents	2	2%
9	Anticonvulsant	1	1%
10	Anticoagulant	1	1%
11	Probiotic	1	1%
12	Antispasmodic	1	1%
13	Serotonin 5 HT3 receptor antagonist	1	1%

 

 

DISCUSSION:

A prospective observational study was conducted to assess the thyroid levels and hypertension in pregnant women. The focus of this study was to review the hypothyroidism and hypertension. The ultimate aim of the study was that it can be beneficial to society. A total of 101 cases were identified, included and analysed for the study from inpatient units of department of Gynaecology, Gandhi hospital, Secunderabad. This study highlights the age group of 21-25 years was mostly presented with hypothyroidism and hypertension followed by the age of 26-30. The present study corresponded with the as study done by Potlukova E et al 2012⁸, Singh V et al 2015⁹.

This study highlights that the gestational hypertension is associated with decrease activity of thyroid hormone. The present study corresponded with the as study done by Ignatius C M et al 2017². In the present study out of 101 cases 49, 29, 17, 6 cases had gestational age of 31-40 weeks, 21-30 weeks, 11-20 weeks, 1-10 weeks respectively. The present study corresponded with the study done by Saraladevi R et al 2016¹⁰.

In the present study out of 101 cases 69 patients were found to be suffering from hypothyroidism in our study, in this TSH levels were found to be increased in most of the patients, maximum 56(81%)cases had TSH levels above 5 ml U/L and remaining 13(19%) cases had TSH levels 0-5 ml U/L, and T3 and T4 levels were mostly found to be normal in our study, maximum 49(71%) cases had T3 levels ranging from 0.92-2.75 nmol/L and minimum 20(29%) cases had T3 levels above 2.76 nmol/L and maximum 64(93%) cases had T4 levels ranging from 4.5-11.2 mcg/dl and minimum 5(7%) cases had T4 level above 11.2 mcg/dl. The present study corresponded with the study done by Singh A et al 2020⁶.

Among the hypothyroidism cases maximum of 31(45%) cases had subclinical hypothyroidism, followed by 25(36%) cases with overt hypothyroidism and 13(19%) cases had euthyroid. The present study corresponded with the as study done by Ignatius C M et al 2017^[2]. In the present study out of 101 cases 53 patients were suffering from hypertension. In which maximum 32(60%) cases had mild preeclampsia, 12(23%) cases had severe preeclampsia and 9(17%) had gestational hypertension. The present study corresponded with the study done by Kumari R et al 2020¹¹.

In the present, study out of 101 cases the incidence of maternal complication was placenta previa (5%), seizures (1%), diabetes mellitus (6%), vaginal bleeding (8%), splenomegaly (1%), anemia (1%), metabolic encephalopathy (1%). The present study corresponded with the study done by Abalovich M et al 2002¹². In the present study out of 101 cases the risk factors associated with pregnancy were found to be Rh –ve pregnancy 5%, past history of abortion 5%. The present study corresponded with the study done by Costumbrado J et al 2021¹³.

We have identified in the study that multivitamins (92%) were drug of choice for most of the patients followed by antihypertensive (82%), thyroid agents(58%), antacids(50%), antibiotics(28%), NSAIDS(8%), progesterone (2%), antifibrinolytic(2%), others(1%). We also found that, around 80% of cases got discharged after treatment with in a period of 1 to 2 weeks. This outcome clearly indicated that a strong and suitable management strategy has been practised by the physicians to treat the patients. This finding match with the length of stay to find that better management strategy leads to lesser length of stay as reported by Kashi Z et al 2015 ¹⁴, Richard K et al 2022¹⁵.

In our present study all the statistical analysis were performed using SPSS software version 29, and the parameters like age, gestational age, length of stay were assessed using one sample t-test and p value was found to be <0.001 which defined as the taken parameters are statistically highly significant. The present study corresponded with the as study done by Ignatius C M et al 2017².

For Test of significance of hypertension and hypothyroidism in pregnant women we used Pearson Chi-square test {χ²-test}

χ²_cal=42.422 {at 95% confidence limit, with degree of freedom=1, χ²_tab=3.841}

χ²_cal >χ²_tab {42.422>3.841} at 5% level of significance. 

Hence, there was statistically significant difference between the hypertension and hypothyroidism in pregnant women. The present study corresponded with the study done by Kumari R et al 2020 ¹⁵.

CONCLUSION:

With this study we have found that decreased thyroid gland activity is linked to gestational hypertension. FT3 and FT4 were significantly normal, whereas TSH levels are higher. Our study concluded that with appropriate evaluation and strict adherence towards management strategy for hypothyroidism and hypertension we can provide enhanced patient outcome. 

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