To Determine the Effect of Various Perinatal Factors on Cord Blood TSH Level of Newborn and To Correlate the Results with Neurodevelopmental Outcome Over Infancy

Authors

  • Apoorvi Saxena
  • Ashvini Kumar Verma
  • Rajesh Kumar Singh

Keywords:

Cord blood TSH, congenital hypothyroidism, maternal factors, perinatal complications, neurodevelopment, newborn screening

Abstract

Cord blood thyroid-stimulating hormone (CB-TSH) measurement is a standard component of newborn screening for congenital hypothyroidism (CH). However, CB-TSH levels may be influenced by maternal and perinatal factors, potentially leading to false-positive results and unnecessary interventions. To evaluate the impact of maternal and perinatal factors on CB-TSH levels and to correlate elevated levels with neurodevelopmental outcomes during infancy. This prospective observational study included 150 neonates delivered at the Integral Institute of Medical Sciences. Detailed maternal history, perinatal events, and antenatal drug exposures were recorded. CB-TSH levels were measured at birth and analyzed using clinical cut-offs and quartiles. Neurodevelopmental assessments were performed at 3, 6, 9, and 12 months using standard developmental milestone checklists. Associations were analyzed using chi-square and Fisher’s exact tests. Elevated CB-TSH levels (≥6.6 mIU/L) were observed in 36.0% of neonates, although the screen-positive rate for CH (CB-TSH >20 mIU/L) was low at 1.3%. Significant associations were found between elevated CB-TSH and maternal hypothyroidism (25.0%), gestational diabetes mellitus (16.7%), and antenatal use of thyroxine or insulin (p = 0.025–0.033). Among perinatal factors, meconium-stained amniotic fluid (41.7%), birth asphyxia (12.5%), and NICU admission (22.9%) showed significant correlations with elevated CB-TSH. Mild delays in language and social domains were observed in infants with elevated TSH, although these did not reach statistical significance (p > 0.05). CB-TSH levels are significantly affected by maternal endocrine conditions and perinatal stressors. Despite a high prevalence of elevated TSH levels, the incidence of confirmed CH and neurodevelopmental delays was low. Careful interpretation of CB-TSH results is essential to avoid overdiagnosis and unnecessary clinical interventions.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Sree NN, Bang A, Banait N, Girish M, Chauhan U, Choudhary A, Jain S. Effect of Various Perinatal Factors on Cord Blood TSH Levels: A Cross-Sectional Study. Indian Journal of Child Health. 2025 Mar 25;12(1):1-9.

Kliegman R, St. Geme J, Blum N, et al. Nelson Textbook of Pediatrics. 22nd ed. Vol. 2. Philadelphia: Elsevier; 2024.

Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017 Mar 1;27(3):315-89.

Eng L, Lam L. Thyroid Function During the Fetal and Neonatal Periods. Neoreviews. 2020;21(1):30-6.

Raguvaran R, Ezhil Vanan NR, Kuzhali S, Gowtham V. A study on mean TSH levels and various perinatal factors affecting TSH level in cord blood of newborn. Int J Acad Med Pharm. 2023;5(3):2257–2260.

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

Al Juraibah F, Alothaim A, Al Eyaid W, AlMutair AN. Cord blood versus heel-stick sampling for measuring thyroid stimulating hormone for newborn screening of congenital hypothyroidism. Annals of Saudi medicine. 2019 Oct;39(5):291-4.

Manglik AK, Chatterjee N, Ghosh G. Umbilical cord blood TSH levels in term neonates: a screening tool for congenital hypothyroidism. Indian Pediatr. 2005 Oct 1;42(10):1029-32.

Rose SR, Wassner AJ, Wintergerst KA, Yayah-Jones NH, Hopkin RJ, Chuang J, Smith JR, Abell K, LaFranchi SH, Bethin KE, Brodsky JL. Congenital hypothyroidism: screening and management. Pediatrics. 2023 Jan 1;151(1).

Gleason A. C, Juul SE. Avery’s diseases of the newborn. 10th ed. Vol. 1. Philadelphia: ELSEVIER; 2018

Kim EY, Park SK, Song CH, LIm SC. Perinatal factors affecting thyroid stimulating hormone (TSH) and thyroid hormone levels in cord blood. Korean Journal of Pediatrics. 2005:143-7.

Armanian AM, Hashemipour M, Esnaashari A, Kelishadi R, Farajzadegan Z. Influence of perinatal factors on thyroid stimulating hormone level in cord blood. Advanced biomedical research. 2013 Jan 1;2(1):48.

Gupta A, Srivastava S, Bhatnagar A. Cord blood thyroid stimulating hormone level—interpretation in light of perinatal factors. Indian pediatrics. 2014 Jan;51:32-6.

Bharath Raj J. DST Manual+ Know your child’s intelligence and how to improve it. Mysore: Swayamsidha Prakashana. 1983.

Raichurkar AV, Jahagirdar R, Padwal MK, Pore MM. Establishing Umbilical Cord Thyroid-stimulating Hormone in Neonates at a Tertiary Care Teaching Hospital for Screening Congenital Hypothyroidism. Indian Journal of Medical Biochemistry. 2021 Sep;25(3):122.

Karthik RN, Udayakumar S, Pratibha K, Pushpalatha K. Congenital hypothyroidism screening by umbilical cord blood thyroid stimulating hormone: a cross-sectional study. Int J Contemp Pediatr [Internet]. 2023 Sep 27 [cited 2025 Jun 14];10(10):1534–8. Available from: https://www.ijpediatrics.com/index.php/ijcp/article/view/5155

Pawar VA, Jain S, Pustake V, Pawar P. Effect of perinatal factors on cord blood thyroid stimulating hormone levels. International Journal of Contemporary Pediatrics. 2023 Apr;10(4):468.

Rathod S, Pradhan R, Lekharu R, Vala J, Kulshrestha M. Neonatal Screening for Congenital Hypothyroidism: A Study Conducted in a Tertiary Care Hospital of Gujarat. Indian Journal of Medical Biochemistry. 2024 Jan;28(1):8-12.

Jillela MR, Keshireddy PR, Goli S. Umbilical cord blood TSH level: correlation with congenital hypothyroidism. Int J Contemp Ped. 2021;8:1204-8.

Venugopalan L, Paranjyothi S, Sankaran A, Prasad HK, Murugesan G, Shanmughasundaram R. Utility of the new Indian Society of Paediatric and Adolescent Endocrinology (ISPAE) guidelines for congenital hypothyroidism screening in a high risk unit. Indian Journal of Pediatrics. 2021 Nov;88:1075-9.

Kale R, Bhagwat M, Nayak C, Akhade K. Newborn Screening For Congenital Hypothyroidism Using Cord Blood Tsh And Variations In Cord Blood Tsh With Maternal And Neonatal Factors: Study From Rural Centre In Chattishgarh, India. Int J Acad Med Pharm. 2022;4(4):480-3.

Downloads

Published

2025-07-07

How to Cite

1.
Saxena A, Verma AK, Singh RK. To Determine the Effect of Various Perinatal Factors on Cord Blood TSH Level of Newborn and To Correlate the Results with Neurodevelopmental Outcome Over Infancy. J Neonatal Surg [Internet]. 2025Jul.7 [cited 2025Sep.21];14(32S):3912-21. Available from: https://jneonatalsurg.com/index.php/jns/article/view/8047

Issue

Vol. 14 No. 32S (2025): Journal of Neonatal Surgery

Section

Original Article

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

You are free to:

  • Adapt — remix, transform, and build upon the material for any purpose, even commercially.

Terms:

  • Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
  • No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.