Hypothyroidism has been associated with an increased risk of preeclampsia and gestational hypertension, placental abruption, preterm delivery, low birth weight, increased rate of caesarean section, perinatal morbidity and mortality, neuropsychological and cognitive impairment, and postpartum hemorrhage. These findings are generally found in women who have less than optimal prenatal care and when the first prenatal visit is not until mid-gestation and thus thyroxine is not started until late in the pregnancy and dose requirements cannot be made in a timely manner. The associated risk of impaired cognitive development and decreased IQ has come under some scrutiny over the years. Maternal hypothyroidism has been linked to lower IQ scores (by four to seven points) in children born to women with untreated hypothyroidism.
Another important factor to consider is that 75-85% of women with preexisting hypothyroidism need significantly more thyroid hormone during pregnancy. This increased requirement is related to a number of factors, including weight gain and increased thyroid binding globulin. For this reason, it is currently recommended that in women with hypothyroidism, TSH should be measured within four to six weeks of conception, four to six weeks after any thyroid medication dose change, and at least once every trimester. Thyroid hormone dose requirements generally decrease to prepregnancy levels after delivery; however, this should be confirmed with the appropriate testing.

Hyperprolactinemia
Excluding pregnancy, hyperprolactinemia accounts for approximately 10-20% of cases of amenorrhea. Women with oligomenorrhea, amenorrhea, or galactorrhea should have a serum prolactin measured. The usual normal range for serum prolactin is 5 to 20 ng/mL. Serum prolactin values between 20 and 200 ng/mL can be found in patients with any cause of hyperprolactinemia. On the other hand, serum prolactin values above 200 ng/mL usually indicate the presence of a lactotroph adenoma. Evaluation of these patients involves ruling out pregnancy and taking a careful history to determine if the cause of hyperprolactinemia can be uncovered (nipple stimulation or certain drugs). If the source is not evident or cannot be determined and the prolactin remains elevated, a pituitary MRI is necessary to rule out a pituitary adenoma. Treatment decisions are based on whether or not there is an adenoma on the MRI, its size and proximity to the optic chiasm, and the desire for pregnancy. Drug therapy includes dopamine agonists or occasionally oral contraceptive agents in women who are not interested in fertility.

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