Newborn Thyroid-Stimulating Hormone Dynamicity as per the Antenatal and Perinatal Factors

Document Type : Original Article


1 Department of Biochemistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

2 Department of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

3 Department of Obstertrics and Gynaecology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India


Background: Recent surge in the diagnoses of congenital hypothyroidism (CH) has necessitated the measurement of newborn TSH levels and understanding of the way various antenatal and perinatal factors influence its dynamicity.
It is a cross-sectional study on newborns delivered or admitted to the All India Institute of Medical Sciences Raipur (AIIMS Raipur), Chhattisgarh, India.
Methods: Dried blood spot analysis of newborn thyroid-stimulating hormone (nTSH) was carried out on 1,216 newborns after ethical clearance. The TSH levels were presented in percentage to determine the distribution in the study population. The mean values were compared within the groups categorized under each variable. The newborns' variables in this study included birth weight, Ponderal index, and neonatal complications. The studied maternal variables included antenatal visits, maternal age, gestational age, anemia, and mode of delivery.
Results: The mean (standard error of the mean) for nTSH was obtained at 3.37 (0.12) mIU/L and 97% of newborns were below 8 mIU/L. Mean nTSH was significantly high in mothers older than 30 years (P=0.019) and those with anemia during the antenatal period (p <0.001). It was significantly raised in babies with complications (P=0.004). Besides, higher values were also observed in low birth weight babies and those with low Ponderal Index. Higher nTSH was observed among newborns born to mothers with a thyroid disorder, those delivered prematurely and/or by cesarean section, and those with no antenatal visits.
Conclusion: It is highly essential to take a precautionary note on the antenatal status of mothers in terms of advanced age, premature delivery, associated maternal diseases, mode of delivery, newborn’s birth weight, and complications which are supposed to influence the dynamicity of thyroid hormones in newborns and result in CH.


  1. Medda E, Olivieri A, Stazi MA, Grandolfo ME, Fazzini C, Baserga M, et al. Risk factors for congenital hypothyroidism: results of a population case-control study (1997–2003). Eur J Endocrinol. 2005; 153(6):765-73. 
  2. Fan P, Luo ZC, Tang N, Wang W, Liu Z, Zhang J, et al. Advanced maternal age, mode of delivery, and thyroid hormone levels in Chinese newborns. Front Endocrinol. 2020; 10:913.
  3. Ozdemir H, Akman I, Coskun S, Demirel U, Turan S, Bereket A, et al. Maternal thyroid dysfunction and neonatal thyroid problems. Int J Endocrinol. 2013; 2013:987843.
  4. Yang Y, Hou Y, Wang H, Gao X, Wang X, Li J, et al. Maternal thyroid dysfunction and gestational anemia risk: meta-analysis and new data. Front Endocrinol. 2020; 11:201.
  5. Zhou J, Luo J, Zhao H, Wang J, Lin F, Zhang H, et al. Risk factors of 125 cases of neonatal congenital hypothyroidism during perinatal period. Zhonghua Liu Xing Bing Xue Za Zhi. 2015; 36(7):747-51.
  6. Ryckman KK, Spracklen CN, Dagle JM, Murray JC. Maternal factors and complications of preterm birth associated with neonatal thyroid stimulating hormone. J Pediatr Endocrinol Metab. 2014; 27(9-10):929-38.
  7. Pawde AA, Kulkarni MP, Unni J. Pregnancy in women aged 35 years and above: a prospective observational study. J Obstet Gynaecol India. 2015; 65(2):93-6. 
  8. Singh P, Hashmi G, Swain PK. High prevalence of cesarean section births in private sector health facilities- analysis of district level household survey-4 (DLHS-4) of India. BMC Public Health. 2018; 18(1):613.
  9. Lakshminarayana SG, Sadanandan NP, Mehaboob AK, Gopaliah LR. Effect of maternal and neonatal factors on cord blood thyroid stimulating hormone. Indian J Endocrinol Metab. 2016; 20(3):317-23. 

10. Herbstman J, Apelberg BJ, Witter FR, Panny S, Goldman LR. Maternal, infant, and delivery factors associated with neonatal thyroid hormone status. Thyroid. 2008; 18(1):67-76.

11. Sheikhbahaei S, Mahdaviani B, Abdollahi A, Nayeri F. Serum thyroid stimulating hormone, total and free T4 during the neonatal period: Establishing regional reference intervals. Indian J Endocrinol Metab. 2014; 18(1):39-43.

12. Yu B, Long W, Yang Y, Wang Y, Jiang L, Cai Z, et al. Newborn screening and molecular profile of congenital hypothyroidism in a Chinese population. Front Genet. 2018; 9:509.

13. World Health Organization. Low birth weight. Geneva: World Health Organization; 2011.

14. Apoorva MS, Thomas V, Kiranmai B. A cross sectional study on socio-demographic and maternal factors associated with low birth weight babies among institutional deliveries in a tertiary care hospital, Hyderabad, Telangana. Int J Community Med Public Health. 2018; 5(11):4901-4.

15. Bhattacharjya H, Das S, Ghosh D. Proportion of low birth weight and related factors in a tertiary care institute of Tripura. Int J Med Public Health. 2015; 5(1):10-3.

16. Rajashree K, Prashanth HL, Revathy R. Study on the factors associated with low birth weight among newborns delivered in a tertiary-care hospital, Shimoga, Karnataka. Int J Med Sci Public Health. 2015; 4(9):1287-90. 

17. Mao H, Yang R, Liu Z. Correlation of congenital hypothyroidism with birth weight and gestational age in newborn infants. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2007; 36(4):378-81.

18. Vigone MC, Capalbo D, Weber G, Salerno M. Mild hypothyroidism in childhood: who, when, and how should be treated? J Endocr Soc. 2018; 2(9):1024-39.

19. Niranjan U, Wright NP. Should we treat subclinical hypothyroidism in obese children? BMJ. 2016; 352:i941.

20. Rezaeian S, Poorolajal J, Moghimbegi A, Esmailnasab N. Risk factors of congenital hypothyroidism using propensity score: a matched case-control study. J Res Health Sci. 2013; 13(2):151-6.

21. Diéguez M, Herrero A, Avello N, Suárez P, Delgado E, Menéndez E. Prevalence of thyroid dysfunction in women in early pregnancy: does it increase with maternal age? Clin Endocrinol. 2016; 84(1):121-6.

22. Raj S, Baburaj S, George J, Abraham B, Singh S. Cord blood TSH level variations in newborn – experience from a rural Centre in southern India. J Clin Diagn Res. 2014; 8(7):PC18-20.

23. Rama Devi AR, Naushad SM. Newborn screening in India. Indian J Pediatr. 2004; 71(2):157-60. 

24. Sundararaman PG. Neonatal thyroid dysfunction-lessons from Indian experience. Thyroid Res Pract. 2013; 10(4):7.

25. Gopalakrishnan V, Joshi K, Phadke S, Dabadghao P, Agarwal M, Das V, et al. Newborn screening for congenital hypothyroidism, galactosemia and biotinidase deficiency in Uttar Pradesh, India. Indian Pediatr. 2014; 51(9):701-5. 

26. Rastogi MV, LaFranchi SH. Congenital hypothy-roidism. Orphanet J Rare Dis. 2010; 5:17.

27. Myrskylä M, Silventoinen K, Tynelius P, Rasmussen F. Is later better or worse? Association of advanced parental age with offspring cognitive ability among half a million young Swedish men. Am J Epidemiol. 2013; 177(7):649-55. 

28. Raatikainen K, Heiskanen N, Heinonen S. Under-attending free antenatal care is associated with adverse pregnancy outcomes. BMC Public Health. 2007; 7(1):268.

29. Drigo RA, Fonseca TL, Werneck-de-Castro JPS, Bianco AC. Role of the type 2 iodothyronine deiodinase (D2) in the control of thyroid hormone signaling. Biochim Biophys Acta. 2013; 1830(7):

30. Rabah SA, Gowan IL, Pagnin M, Osman N, Richardson SJ. Thyroid hormone distributor proteins during development in vertebrates. Front Endocrinol. 2019; 10:506.

31. Kaluarachchi D, Allen D, Eickhoff J, Dawe S, Baker M. Thyroid-stimulating hormone reference ranges
for preterm infants. Pediatrics. 2019; 144(2):

32. Liu C, Wang K, Guo J, Chen J, Chen M, Xie Z, et al. Small for gestational age is a risk factor for thyroid dysfunction in preterm newborns. BMC Pediatrics. 2020; 20(1):179.

33. Forhead AJ, Fowden AL. Thyroid hormones in fetal growth and prepartum maturation. J Endocrinol. 2014; 221(3):R87-103.

34. Roje D, Banovic I, Ivo B, Tadin I, Ivica T, Vucinović M, et al. Gestational age--the most important factor of neonatal ponderal index. Yonsei Med J. 2004; 45(2):273-80.