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Thyroid Disease in Pregnant Women with SLE

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Introduction

Throughout the last twenty years it has become clear that systemic lupus erythematosus (SLE) face higher risks of miscarriages and preterm delivery (PTD). Studies have also demonstrated that thyroid disease, which is common in pregnancies, is also associated with complicated pregnancies. Given that PTD has gradually increased over the years and that prevalence is higher among those women who suffer SLE, Stagnaro-Green, et al. (2011) decided to conduct a study where they further explored what the relationship between SLE and PTD is. The study was conducted with four specific objectives in mind. First, the researchers wished to determine what the prevalence of undiagnosed hypothyroidism in pregnant women with SLE is. Second, researchers wanted to determine what the prevalence of thyroid antibodies in pregnant women with SLE is. Third, they wanted to determine if either hypothyroidism and/or thyroid antibodies increased the risks of miscarriages or PTD in women with SLE (when compared to those that suffered neither hypothyroidism nor had thyroid antibodies, but did have SLE). Finally, researchers wished to determine what the prevalent of postpartum thyroiditis in women with SLE is (Stagnaro-Green, et al., 2011). 

Methods

The study was conducted using a group of 63 women, all of which were a part of the Hopkins Lupus Cohort. Furthermore, the study was sanctioned and approved by both the John Hopkins Institutional Review Board and the IRB at Hackensack University Medical Center. Finally, in discussing the subjects used, they all met the criteria for SLE and any delivery made before 37 weeks was considered preterm (Stagnaro-Green, et al., 2011). 

Moving on to the statistical analysis made, the subjects were divided into four groups: women with no thyroid dysfunction, women who were taking levothyroxine before their pregnancy, women who developed hypothyroidism during pregnancy and women with PPT. ANOVA models, as well as t-tests, Chi Square tests and Fisher’s exact tests for binary variables were also used throughout the statistical analysis that was conducted.

Results

The experimental group of subjects was comprised of 63 women that suffered from SLE. Out of those 63, 13% were taking levothyroxine before they were impregnated. Of those who were not taking levothyroxine (55), only 43 were evaluated for PPT, and 14% of those 43 developed PPT (as a note, most subjects who developed PPT were on steroid treatment, either during the pregnancy or during postpartum). In discussing thyroid antibodies, it was found that out of the initial sample of 63 women, 23.8% tested positive for antibodies (Stagnaro-Green, et al., 2011). However, none of the 43 women who were tested for PPT drew positive for thyroid antibodies during their pregnancies. Based on this, it becomes clear that there were no significant demographical differences between the tested subjects, but there were significant differences in the prevalence of PTD between women with SLE and thyroid disease (67%), and women that suffered only from SLE (18%) (Stagnaro-Green, et al., 2011).

Discussion

After finalizing the study the researchers were able to extract six general conclusions. First, 13% of women were on thyroid hormone replacement before they were impregnated. Second, 10.9% developed subclinical hypothyroidism while pregnant. Third, 14% of women developed PPT while pregnant (Stagnaro-Green, et al., 2011). Fourth, having thyroid antibodies throughout the pregnancy did not allow for any predictions on the development of PPT. Fifth, women with thyroid disease presented a prevalence of PTD much higher than those without thyroid disease. Sixth, there was no difference in terms of testing positive for thyroid antibodies between women who had PTD and those who did not have PTD (Stagnaro-Green, et al., 2011). Based on this, it can be said that the researchers were able to fulfill the objectives that motivated their studies and test their initial hypotheses. It was possible to demonstrate that pregnant women with SLE had a higher prevalence of developing thyroid disease than pregnant women without SLE. It was also possible to demonstrate that SLE and thyroid disease increases the prevalence of miscarriages and PTD among women. 

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