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Pregnancy outcome in women treated with methimazole or propylthiouracil during pregnancy

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Abstract

Purpose

Control of thyroid function in hyperthyroid women during pregnancy is based on antithyroid drugs (ATD) [propylthiouracil (PTU) and methimazole (MMI)]. While a teratogenic effect has been suggested for MMI and, more recently, for PTU, a clear demonstration is still lacking. Aim of this study was to assess the safety of ATD during pregnancy.

Methods

A total of 379 pregnancies were retrospectively recruited in eight Italian Departments of Endocrinology and divided in five groups: (1) MMI-treated and euthyroid throughout pregnancy (n = 89); (2) MMI-treated and hyperthyroid on at least two occasions (n = 35); (3) PTU-treated women and euthyroid throughout pregnancy (n = 32); (4) PTU-treated women and hyperthyroid on at least two occasions (n = 20); and (5) non-ATD-treated (n = 203). Data on maternal thyroid function, miscarriages, type of delivery, neonatal weight, length and TSH, perinatal complications and congenital malformation were analyzed.

Results

The gestational age at delivery, the rate of vaginal delivery, neonatal weight, length and neonatal TSH did not significantly differ among groups. In all groups, the rates of spontaneous miscarriage and of major congenital malformations were not higher than in the general population. No newborns were born with a phenotype similar to those described in the “MMI embryopathy”.

Conclusions

While a clear demonstration of a teratogenic effect of MMI is currently lacking, it seems reasonable to follow the current guidelines and advice for PTU treatment in hyperthyroid women during the first trimester of pregnancy. Further, large and prospective worldwide studies will be needed to fully clarify the issue of ATD safety during pregnancy.

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Acknowledgments

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, Cisanello, 56124, Pisa, Italy

    E. Gianetti, L. Russo, E. Martino, P. Vitti & M. Tonacchera

  2. Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

    F. Orlandi

  3. Unit of Internal Medicine and Endocrinology, Salvatori Maugeri Foundation, University of Pavia, Pavia, Italy

    L. Chiovato

  4. Department of Internal Medicine, University of Genova, Genoa, Italy

    M. Giusti

  5. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    S. Benvenga

  6. Interdepartmental Program of Molecular and Clinical Endocrinology and Women’s Endocrine Health, University Hospital of Messina, Messina, Italy

    S. Benvenga, M. Moleti & F. Vermiglio

  7. Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy

    P. E. Macchia

  8. Department of Medicine and Surgery, University of Salerno, Salerno, Italy

    M. Vitale

  9. Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy

    C. Regalbuto

  10. Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy

    M. Centanni

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  1. E. Gianetti
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  2. L. Russo
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  3. F. Orlandi
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Correspondence to E. Gianetti.

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On behalf of the Italian Society of Endocrinology.

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Gianetti, E., Russo, L., Orlandi, F. et al. Pregnancy outcome in women treated with methimazole or propylthiouracil during pregnancy. J Endocrinol Invest 38, 977–985 (2015). https://doi.org/10.1007/s40618-015-0281-z

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  • DOI: https://doi.org/10.1007/s40618-015-0281-z

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