Maternal thyroid function during gestation is related to breech presentation at term

Objective To study the relationship between suboptimal maternal thyroid function during gestation and breech presentation at term. Design Prospective follow-up study during three trimesters of gestation. Patients A total of 1058 Dutch Caucasian healthy pregnant women were prospectively followed from 12 weeks gestation until term (>= 37 weeks) delivery. Measurements Maternal thyroid parameters [TSH, free T4 (FT4) and auto-antibodies to thyroid peroxidase] were assessed at 12, 24 and 36 weeks gestation as well as foetal presentation at term. Results At term, 58 women (5.5%) presented in breech. Compared with women with foetuses in the cephalic position, those women who presented in breech at term had significantly higher TSH concentrations, but only at 36 weeks gestation (P = 0.007). No between group differences were obtained for FT4 level at any assessment. The prevalence of breech presentation in the subgroup of women with TSH >= 2.5 mIU/l (90th percentile) at 36 weeks gestation was 11%, compared with 4.8% in the women with TSH < 2.50 mIU/l (P = 0.006). Women with TSH below the 5th percentile had no breech presentations. Breech position was significantly and independently related to high maternal TSH concentration (>= 2.5 mIU/l) at 36 weeks gestation (O.R.: 2.23, 95% CI: 1.14- 4.39), but not at 12 and 24 weeks gestation. Conclusions Women with TSH levels above 2.5 mIU/ l during end gestation are at risk for breech presentation, and as such for obstetric complications.