Prevalence of hypothyroidism among pregnant women and associated feto-maternal outcomes in India: Systematic review and meta-analysis

Subhanwita Manna; Reema Mukherjee; Vani Kandpal; Mrunali Zode; Bharati Kulkarni; Tanica Lyngdoh

doi:10.25259/IJMR_2554_2025

View/Download PDF

Buy Reprints

PDF

Translate this page into:

Systematic Review

163 (

); 745-762

doi:

10.25259/IJMR_2554_2025

Prevalence of hypothyroidism among pregnant women and associated feto-maternal outcomes in India: Systematic review and meta-analysis

Subhanwita Manna¹, Reema Mukherjee¹, Vani Kandpal¹, Mrunali Zode¹, Bharati Kulkarni², Tanica Lyngdoh^1,3,

1Division of Reproductive, Child Health, and Nutrition, Indian Council of Medical Research (ICMR), Delhi, India

2ICMR-National Institute of Nutrition, Hyderabad, Telangana, India

3Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India

For correspondence: Dr Tanica Lyngdoh, Department of Reproductive, Child Health and Nutrition, Indian Council of Medical Research, Delhi 110 029, India e-mail: tanica.lyngdoh@gmail.com

Received: 2025-09-17, Accepted: 2026-02-02, Epub ahead of print: 2026-05-30, Published: 2026-06-10

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Manna S, Mukherjee R, Kandpal V, Zode M, Kulkarni B, Lyngdoh T. Prevalence of hypothyroidism among pregnant women and associated feto-maternal outcomes in India: Systematic review and meta-analysis. Indian J Med Res. 2026;163:745-62. doi: 10.25259/IJMR_2554_2025

Abstract

Background and objectives

Hypothyroidism is the most common thyroid disorder during pregnancy and, if not managed adequately, increases the risk of adverse foeto-maternal outcomes. The present systematic review and meta-analysis was conducted to assess the prevalence of hypothyroidism among Indian pregnant women and related foeto-maternal outcomes.

Methods

A systematic search was conducted across PubMed, Google Scholar, and preprint servers to identify observational studies reporting the prevalence of hypothyroidism and associated foeto-maternal outcomes among Indian pregnant women. A random-effects model was utilised to pool effect sizes, and heterogeneity was assessed using I² statistic. Funnel plots, along with Begg’s and Egger’s tests, were used to assess publication bias. Data were analysed using STATA version 17.

Results

A total of 60 studies were included. The pooled prevalence of hypothyroidism among pregnant women was 17% [95% confidence interval (CI): 14%, 19%] with subclinical hypothyroidism at 15% (95% CI: 12%, 18%) and overt hypothyroidism at 3% (95% CI: 3%, 4%). In women with subclinical hypothyroidism, the pooled prevalence of adverse maternal outcomes was 9% (95% CI: 6%, 11%), while the prevalence of adverse foetal outcomes was 11% (95% CI: 9%, 14%). The pooled prevalence was 18% for preterm birth (95% CI: 11%, 25%), 17% for low birth weight (95% CI: 10%, 25%), 7% for intrauterine death (95% CI: 2, 14%), and 2% for stillbirth (95% CI: 0, 4%). Among women with overt hypothyroidism, the prevalence of adverse maternal and foetal outcomes was 12% (95% CI: 10%, 15%) and 14% (95% CI: 11%, 17%), respectively. The pooled prevalence was 22% for low birth weight (95% CI: 13%, 31%), 16% for preterm birth (95% CI: 9%, 24%), 16% for intrauterine death (95% CI: 7%, 27%), and 6% for stillbirth (95% CI: 1%, 13%). Most studies used trimester-specific TSH cut-offs based on the American Thyroid Association guidelines. One fourth (n=15) of the 60 studies applied alternative thresholds, with upper limits for normal TSH varying from 4.0-10.0 mIU/L.

Interpretation and conclusions

Keywords

Adverse effect

Hypothyroidism

India

Neonatal outcomes

Pregnant women

Prevalence

Pregnancy outcomes

Show Related Articles from PubMed

Globally, the prevalence estimates of hypothyroidism during pregnancy vary considerably.^1-5 In India, studies report a wide range of prevalence estimates for maternal hypothyroidism.⁶ A 2021 meta-analysis of 61 studies in pregnant women estimated an overall prevalence of hypothyroidism as 11.1%, 9.5% subclinical, and 2.7% overt hypothyroidism.⁶ A population-based cohort in North India reported that nearly 29% of pregnant women in early pregnancy had hypothyroidism, with higher susceptibility among those with anaemia or overweight.⁷

Untreated or inadequately managed hypothyroidism in pregnancy can have far-reaching consequences, including miscarriage, preeclampsia, and placental complications in the mother as well as preterm birth, low birth weight and impaired neurodevelopment in the child.^8-12 Emerging evidence suggests that hypothyroidism in pregnancy is shaped not only by iodine deficiency but also by a complex interplay of nutritional factors, environmental exposures, metabolic conditions, and autoimmune processes.^13-17 This multifactorial etiology highlights the need for a deeper understanding of risk pathways and outcomes, especially among Indian women.

While previous research has explored the burden of hypothyroidism in pregnancy, a focused synthesis of the prevalence of associated complications remains lacking in the Indian context. We could not find any review on adverse maternal and foetal outcomes in this population. The present study aims to conduct a meta-analysis to estimate the prevalence of hypothyroidism and its associated adverse outcomes, thereby providing evidence to support the implementation of screening protocols.

Methods

Search strategy

A systematic literature search was conducted across PubMed, Google Scholar, and manual searching in preprint servers. All studies published up to January 2025 were considered, regardless of study type or language. A forward and backward citation techniques were applied to ensure comprehensive inclusion of the relevant literature.

Separate search strategies were developed for each database (Supplementary Table I). The search strategy included a combination of keywords and Medical Subject Headings (MeSH) terms like: ‘thyroid’, ‘hypothyroidism’, ‘thyroid disorder’, ‘pregnancy’, ‘pregnant women’, ‘antenatal’, ‘prenatal’, ‘prevalence’, ‘burden’, ‘incidence’, ‘adverse effects’, ‘birth outcome’, ‘side effects’, ‘maternal outcome’, ‘foetal outcome’, among others. Boolean operators (AND/OR) and database-specific syntax were applied to construct a robust and comprehensive search strategy. This review was registered with Open Science Framework (OSF) [ https://doi.org/10.17605/OSF.IO/PQJX2 ].

Supplementary Table I

Download

Selection criteria

Studies were included if they - (i) enrolled pregnant women screened and diagnosed with hypothyroidism at the first antenatal visit, irrespective of the trimester, (ii) were conducted in community/hospital (cross-sectional, cohort studies were considered eligible where thyroid function was assessed at baseline or first antenatal visit), (iii) reported prevalence of hypothyroidism (overt, subclinical, or overall), (iv) reported prevalence of adverse foeto-maternal outcomes among pregnant hypothyroid women, (v) India-specific studies, (vi) diagnosis based on TSH level, (vii) studies published in English and with full-text availability.

Case-control studies, experimental studies, ecological reports, case reports, case series, editorials and protocols were excluded.

Screening and data extraction

Two reviewers independently searched all databases and duplicate records were removed. The de-duplicated set of records was subsequently imported into Rayyan, a web-based tool designed to facilitate an organised and transparent screening process for systematic reviews.¹⁸ Two reviewers (VK and SM) independently screened titles and abstracts, followed by full-text screening of potentially eligible articles. Any disagreements during the screening process were resolved through discussion and, when necessary, by consultation with a third reviewer (MZ). Similarly, data extraction was conducted independently by SM and VK, with discrepancies resolved by consensus or by involving the third reviewer (MZ). Information regarding author, year of publication, study setting (community/hospital-based), study location, definition and diagnostic criteria of hypothyroidism, sample size, prevalence, and maternal and foetal adverse outcomes. A data extraction table was prepared in Microsoft Excel for further analysis. Articles searched were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)¹⁹ statement and reporting guidelines to ensure scientific precision.

Quality assessment

We assessed the quality of the included cross-sectional and cohort studies using the Joanna Briggs Institute (JBI) scale. A separate checklist was adopted for cohort, descriptive, and analytical cross-sectional study designs.^20,21 The following factors were assessed by this tool: the clarity of the inclusion criteria, the suitability of the recruitment and sampling strategies, the validity and reliability of the study tool, the adequacy of the sample size, the detailed description of the study subjects, the data analysis with adequate coverage of the identified sample, the use of valid methods for condition identification, the measurement of the condition consistently and reliably for all participants, the use of appropriate statistical analysis, and the adequacy of the response rate. Every item on the checklist received a rating of ‘Yes,’ ‘No,’ ‘Unclear,’ or ‘Not Applicable,’ and each study was given an overall quality rating.

We rated ‘Yes’ as ‘1’ and rest of the options as ‘0’. Two reviewers independently carried out the appraisal, and any disagreements were settled by discussion or, if necessary, consultation with a third reviewer.

The results of the quality assessment were used to interpret the strength of the evidence and, when appropriate, were further investigated through sensitivity analysis. Studies were not eliminated based only on quality scores.

Data synthesis and management

The prevalence of hypothyroidism was calculated by dividing the number of pregnant women with hypothyroidism by the total study participants. The effect size of each of the studies was calculated by prevalence estimates of overall hypothyroidism, Subclinical and overt hypothyroidism in pregnant women in the included studies. Pooled prevalence of maternal and foetal adverse outcomes was also reported separately for hypothyroidism, subclinical and overt. The random-effects model with restricted maximum likelihood (REML) estimation was used to pool prevalence estimates. In addition, Freeman-Tukey (double arcsine) transformation for proportions was applied to stabilise the variances. Heterogeneity of the studies was estimated using the I² statistic and interpreted based on commonly used thresholds: values below 25% were considered to indicate low heterogeneity, 25-50% moderate, and values above 50% substantial heterogeneity. Sensitivity analysis was performed excluding low-quality (<5) studies. Meta-regression was performed to explore the influence of study-level covariates on pooled estimates. Funnel plots and Begg and Egger’s tests were performed to evaluate publication bias. Estimates were reported as a proportion with a 95% confidence interval. P value <0.05 was considered statistically significant. All analyses were performed using STATA v17.0 using ‘Metaprop’ and ‘meta’ commands.

Results

We identified 959 articles from PubMed, Google Scholar, and the Cochrane database. After removal of duplicates total of 731 studies were screened for title and abstract, 533 studies were assessed for eligibility, of which 60 studies met our inclusion criteria and were included in the study. The summarisation of search results was presented using a PRISMA flow diagram¹⁹ ( Fig. 1).

Of these, 34 studies were based on population-based cohorts, and 26 were cross-sectional. Of the 60 studies,^7,22-80 53 studies reported the prevalence of overall hypothyroidism, 47 reported the prevalence of subclinical (n=44, 342), and 42 reported the prevalence of overt hypothyroidism (n=42,360) among pregnant women. The majority of the studies were hospital-based; only one study was community-based ( Table)^7,22-80.

Table. Characteristics of the studies included in the review

Sr. No.	Author and Year	Sample size	Settings	State	Trimester	Definition	Method	Outcomes reported	Quality score
1	Marwaha et al²², 2008	541	Hospital based	New Delhi	Any	TSH (0.27–4.2 mIU/ml); FT3 (3.7–7.2 pM/l), FT4 (12.0–23.0 pM/l); Definition for SCH and OH not specified. Trimester-specific reference values not specified.	Electro-chemiluminescent immunoassay	Prevalence of hypothyroidism, OH and SCH	8
2	Sahu et al²³, 2010	633	Hospital based	Uttar Pradesh and New Delhi	Second	The normal range for TSH is 0.5–5.5 mIU/L. TSH>5.5 mIU/L or <0.5 mIU/L were considered abnormal. OH if high TSH with low-free T4; SCH if high TSH in the presence of normal blood levels of thyroid hormone	Chemiluminescence Immunoassay	Prevalence of hypothyroidism, OH and SCH, and fetomaternal outcomes in OH and SCH	8
3	Nambiar et al²⁴, 2011	483	Hospital based	Maharashtra	First	The normal range for TSH (0.4–4), FT3: (0.23–0.63), FT4 (10.3–24.45)	Chemiluminescence Immunoassay	Prevalence of hypothyroidism and fetomaternal outcomes (no classification between SCH or OH)	9
4	Dhanwal et al²⁵, 2013	1000	Hospital based	New Delhi	First	Hypothyroidism if TSH > 4.5 mIU/L; SCH if TSH >4.5 mIU/L and normal free T4; OH if TSH >4.5 mIU/L and low free T4	ELISA	Prevalence of hypothyroidism, OH and SCH	8
5	Konin et al²⁶, 2013	400	Hospital based	Karnataka	First	Normal reference values for TSH (0.4-4.2 uIU/ml), FT3 (2.0-3.8pg/ml), FT4 (0.80-2.70ng/dl); Definition for SCH not specified.	Not specified	Prevalence of hypothyroidism and SCH	7
6	Ajmani et al²⁷, 2014	400	Hospital based	Karnataka	Second	As per ATA 2011; SCH if TSH >3.0 µIU/l and normal Free T4 (0.8–2.0 ng/dl); OH if TSH >3.0 µIU/l with low Free T4 (<0.8 ng/dl) First trimester, 0.1–2.5 µIU/ml; second trimester, 0.2–3.0 µIU/ml; and third trimester, 0.3–3.0 µIU/ ml	ELISA	Prevalence of hypothyroidism, OH and SCH, and fetomaternal outcomes in OH and SCH	7
7	Jaiswal et al²⁸, 2014	334	Hospital based	Karnataka	First	Hypothyroidism if TSH >2.5 mIU/L for the first trimester; normal reference range for free T4 (0.89–1.76 ng/dL); OH if high TSH with low-free T4; SCH if high TSH with normal free T4	Chemiluminescence Immunoassay	Prevalence of hypothyroidism, OH and SCH	8
8	Nabhi et al²⁹, 2014	322	Hospital based	Telangana	Second	As per ATA 2011; SCH if TSH>3.0 mIU/L, normal T4 and T3; OH if TSH >3.0 mIU/L and T4<10 mcg/dl1st trimester: 0.1 to 2.5 m IU/L, 2nd trimester: 0.2 to 3.0m IU/L, and 3rd trimester: 0.3 to 3.0 mIU/L.	Not specified	Prevalence of hypothyroidism, OH and SCH	8
9	Rupali M et al³⁰, 2014	800	Hospital based	West Bengal	Third	Normal range for TSH (0.2-3.0 miu/l). SCH if TSH >3 miu/l with normal level of free T4 (0.8-2ng/dl).	Chemiluminescent enzyme immunometric assay	Prevalence of SCH and fetomaternal outcomes in SCH	7
10	Bose et al³¹, 2015	1152	Hospital based	Madhya Pradesh	First	Hypothyroidism, if TSH >2.5 mIU/ml; SCH if TSH >2.5 mIU/ml and normal Free T4 (normal range 0.7–1.48 ng/dl); OH if TSH >2.5 mIU/ml with low Free T4	Chemiluminescent Microparticle Immunoassay (CMIA)	Prevalence of hypothyroidism, OH and SCH	8
11	Kishore et al³², 2015	263	Hospital based	Chhattisgarh	First	OH if TSH >2.5 IU/L with a decreased FT4 or TSH levels ≥10.0 mIU/L; SCH if TSH between 2.5 and 10mIU/L with a normal FT4	ELISA	Prevalence of hypothyroidism, OH and SCH, and fetomaternal outcomes in OH and SCH	8
12	Murty et al³³, 2015	1340	Hospital based	Telangana	Any	As per ATA 2011; SCH if TSH>3.0 mIU/L and normal T4 and T3, OH if TSH >3.0 mIU/L and T4 <7.5 mcg/dl1st trimester - 0.1 to 2.5 mIU/L, 2nd trimester - 0.2 to 3.0 mIU/L and 3 rd trimester - 0.3 to 3.0 mIU/L	Chemiluminescence Immunoassay	Prevalence of hypothyroidism, OH and SCH	8
13	Padmavathi et al³⁴, 2015	1000	Hospital based	Andhra Pradesh	First	The normal range for TSH: First trimester (0.03-2.3 µIU/ml); second (0.03-3.7 µIU/ml) and third (0.13 - 3.4 µIU/ ml)The normal range for FT4: First trimester (0.86-1.77 ng/dl), second (0.63-1.39 ng/dl); and third (0.16-1.12 ng/dl)Definition for SCH and OH not specified.	Chemiluminescent Microparticle Immunoassay (CMIA)	Prevalence of hypothyroidism	4
14	Pavanaganga et al³⁵, 2015	1663	Hospital based	Karnataka	Any	As per ATA 2011 and ES 2012 SCH if TSH >2.5mIU in first trimester, >3mIU in second and third trimester with normal free T3 and T4 levels; OH if TSH >10mIU/l with low free T3 and T4 levels.	Chemiluminescence Immunoassay	Prevalence of hypothyroidism, OH and SCH, and maternal outcomes in OH and SCH	6
15	Rajput et al³⁶, 2015	461	Hospital based	Haryana	First	The normal range for TSH (0.35–5.5 mIU/L), FT3 (2.3–4.2 pg/mL), FT4 (0.89–1.76 ng/dL)Trimester-specific cut-off values for TSH, first (0.1–2.5 mIU/L), second (0.2–3.0 mIU/L) and third (0.3–3.0 mIU/L)OH if TSH>2.5 mIU/L and FT3, FT4 below the reference range; SCH if TSH>2.5 mIU/Land FT3, FT4 in the normal range	Chemiluminescence Immunoassay	Prevalence of hypothyroidism, OH and SCH	8
16	Singh et al³⁷, 2015	400	Hospital based	Manipur	First and Second	As per ATA 2011; Normal range for TSH: first trimester (0.1-2.5 mlu/L) and second (0.3-3 mlu/L) SCH if TSH > 3 mlu/L with normal FT4; OH if TSH > 3 mlu/L with FT4 < 7.5 mcg/dl	Chemiluminescence Immunoassay	Prevalence of hypothyroidism, OH and SCH	8
17	Begum et al³⁸, 2016	9117	Hospital based	Assam	Any	Hypothyroidism if TSH > 3.0 mU/L; Definition for SCH and OH not specified. Trimester-specific reference values not specified.	Vitros 5600	Prevalence of hypothyroidism and fetomaternal outcomes (no classification between SCH or OH)	7
18	Dhanwal et al³⁹, 2016	2955	Hospital based	New Delhi	Any	As per ATA 2011; The normal range for TSH: first trimester (<2.5 mIU/L) and second and third (<3.0 mIU/L)	Electro-chemiluminescent immunoassay	Prevalence of hypothyroidism	8
19	Mandal et al⁴⁰, 2016	510	Hospital based	West Bengal	First	Normal range for TSH (0.1-2.5 μIU/mL) and FT4 (0.8-1.7 ng/dl)SCH if TSH >2.5 μIU/mL and normal FT4; OH if TSH>10 μIU/mL and FT4 less than normal	Chemiluminescence Immunoassay	Prevalence of hypothyroidism, OH and SCH	7
20	Saraladevi et al⁴¹, 2016	1000	Hospital based	Telangana	First	The normal range for TSH: first trimester (0.1 to 2.5 m IU/L), second (0.2 to 3.0 mIU/L) and third (0.3 to 3.0 mIU/L)SCH if high TSH level with normal fT4, fT3 level; OH if high TSH level with fT4 and fT3 less than normal range	Not specified	Prevalence of hypothyroidism, OH and SCH, and fetomaternal outcomes in OH and SCH	5
21	Shivanagappa et al⁴², 2016	999	Hospital based	Karnataka	Any	Hypothyroidism if TSH >3μIU/ml; Definition for SCH and OH not specified. Trimester-specific reference values not specified.	Chemiluminescence Immunoassay	Prevalence of hypothyroidism, OH and SCH, and foetal outcomes among OH and SCH	6
22	Singh et al⁴³, 2016		Hospital based	Jammu	Any	Normal ranges for TSH (0.5 to 5 mU/L), T3 (0.8 to 1.6 ng/mL or 80 to 160 ng/dL) and T4 (60 to 120 ng/mL or 6 to 12 µg/dL)	Radioimmunoassay	Prevalence of OH and SCH and fetomaternal outcomes in SCH	4
23	Tiwari et al⁴⁴, 2016		Hospital based	New Delhi	Any	Normal range for TSH (0.3–6.2 mIU/L) and free T4 (0.76-2.24 ng/dL).Hypothyroidism if TSH >6.2 mIU/L; OH if elevated TSH with low free T4; SCH if elevated TSH with normal FT4.	ELISA	Fetomaternal outcomes among hypothyroid pregnant women (no classification between SCH or OH)	6
24	Dubey et al⁴⁵, 2017	200	Hospital based	Sikkim	First and Second	As per ATA 2011; The normal range for TSH: first trimester (0.1 to 2.5 mIU/l), second (0.2 to 3.0 mIU/l), third (0.3 to 3.0 mIU/l)	Not specified	Prevalence of hypothyroidism, OH and SCH, and fetomaternal outcomes (no classification between SCH or OH)	7
25	Gedam et al⁴⁶, 2017	350	Hospital based	Maharashtra	Any	The normal range for TSH (0.35-5.5 mIU/l), Free T3 (1.7-4.2 pg/ml), and Free T4 (0.7-1.8 ng/dl)The normal range for TSH: First trimester (0.1-2.5mIU/L) Second (0.2-3mIU/), Third (0.3-3 mIU/L)OH if elevated TSH with low FreeT3, FreeT4; SCH if TSH >2.5mIU/L with FreeT3, FreeT4 in normal range.	Not specified	Prevalence of hypothyroidism, OH and SCH	8
26	Indira et al⁴⁷, 2017	333	Hospital based	Andhra Pradesh	Any	As per ATA 2011; First trimester (0.1-2.5 mIU/L), second (0.2-3.0 mIU/L), and third (0.3-3 mIU/L); free T4 (0.7-1.8 ng/mL) and free T3 level (1.7-4.2 pg/mL)SCH if elevated TSH with normal free T3 and T4 levels; OH if elevated TSH with free T3 and T4 less than normal range.	Chemiluminescence Immunoassay	Prevalence of hypothyroidism, OH and SCH	7
27	Pokhanna et al⁴⁸, 2017	300	Hospital based	Madhya Pradesh	Second	As per ATA 2011; First trimester (0.1-2.5 mIU/L), second (0.2-3.0 mIU/L), and third (0.3-3 mIU/L)	Direct immunoassay	Prevalence of hypothyroidism, OH and SCH, and fetomaternal outcomes in OH and SCH	7
28	Sannaboraiah et al⁴⁹, 2017	200	Hospital based	Karnataka	Any	As per European Thyroid Association Guidelines 2014 SCH if TSH >2.5mIU/L in the first trimester, >3mIU/L and >3.5mIU/L in the second and third trimester, respectively, provided normal free T3 and T4	Not specified	Prevalence of hypothyroidism and SCH, and feto-maternal outcomes in SCH	6
29	Usha Devi et al⁵⁰, 2017	1000	Hospital based	Andhra Pradesh	First	No reference ranges specified	Chemiluminescence Immunoassay	Prevalence of hypothyroidism, OH and SCH, and fetomaternal outcomes in OH and SCH	6
30	Bansal et al⁵¹, 2018	101	Hospital based	Uttar Pradesh	Any	The normal range for TSH: first trimester (0.1-2.5mIU/l), second (0.2-3mIU/l), third (0.3-3mIU/l)	Not specified	Prevalence of hypothyroidism, OH and SCH	2
31	Gupta et al⁵², 2018	1268	Hospital based	Maharashtra	Any	As per ATA 2011; The normal range for TSH: first trimester (0.1 to 2.5 mIU/l), second (0.2 to 3.0 mIU/l), third (0.3 to 3.0 mIU/l).	Chemiluminescence Immunoassay	Prevalence of hypothyroidism, OH and SCH, and fetomaternal outcomes in OH and SCH	8
32	Hymavathi et al⁵³, 2018	1000	Hospital based	Andhra Pradesh	Any	No reference ranges specified.	Not specified	Prevalence of hypothyroidism, OH and SCH	4
33	Korde et al⁵⁴, 2018	705	Hospital based	Maharashtra	First	ACOG guidelines 2015The normal range for TSH: first trimester: 0.1-2.5 µIU/ml, second (0.2-3.0 µIU/ml), third (0.3-3.0 µIU/ml)The normal range for T3 (60-200 ng/dl) and T4 (4.5-12 µgm/dl)	Not specified	Prevalence of hypothyroidism, OH and SCH	7
34	Kumari et al⁵⁵, 2018a	720	Hospital based	Uttar Pradesh	First and Second	As per ATA 2011; The normal range for TSH: first trimester (0.1 to 2.5 mIU/l), second (0.2 to 3.0 mIU/l), third (0.3 to 3.0 mIU/l).SCH if elevated TSH with normal fT3 and fT4 levels; OH if elevated TSH with free T3 and T4 levels less than the normal range.	Not specified	Prevalence of hypothyroidism, OH and SCH, and fetomaternal outcomes in OH and SCH	5
35	Kumari et al⁵⁶, 2018b	4701	Hospital based	Andhra Pradesh	Any	As per ATA 2011; The normal range for TSH: first trimester (0.1 to 2.5 mIU/l), second (0.2 to 3.0 mIU/l), third (0.3 to 3.0 mIU/l).	Not specified	Prevalence of hypothyroidism, OH and SCH	7
36	Pahwa et al⁵⁷, 2018	100	Hospital based	Punjab	First	The normal range for TSH: First trimester (0.1-2.5mIU/L) Second (0.2-3mIU/), Third (0.3-3 mIU/L)The normal range for free T3 (1.7-4.2pg/ml) and free T4 (0.7-1.8ng/dl)	Not specified	Prevalence of hypothyroidism, OH and SCH	5
37	Panda et al⁵⁸, 2018	428	Hospital based	Odisha	Any	As per ATA 2011; Normal range for TSH: first trimester (0.1 to 2.5 mIU/l), second (0.2 to 3.0 mIU/l), third (0.3 to 3.0 mIU/l).OH if elevated TSH with FT4 below the reference range or TSH ≥10 mIU/L irrespective of the FT4 level; SCH if TSH between 2.5 mIU/L and 10 mIU/L with FT4 in the normal range	Electro-chemiluminescent immunoassay	Prevalence of hypothyroidism, OH and SCH	7
38	Pillai et al⁵⁹, 2018	1000	Hospital based	Kerela	First	Normal range for TSH: first trimester (0.1-2.5mIU/L).OH if TSH >10mIU/L or elevated TSH with a low free T4; SCH if elevated TSH with a normal free T4	Not specified	Prevalence of hypothyroidism, OH and SCH	9
39	Agarwal et al⁶⁰, 2019	250	Hospital based	New Delhi	First	Hypothyroidism if TSH >4.5mIU/L; OH if free T4 level <8.5 pmol/L; SCH if free T4 level >8.5pmol/L	ELISA	Prevalence of hypothyroidism	6
40	Diyora et al⁶¹, 2019	200	Hospital based	Gujarat	First	Normal range for TSH (0.4-2.5 mU/l), T3 (0.5-2.0 ng/ml), and T4 (53-121 ng/ml).OH if elevated TSH with T3, T4 below the reference range; SCH if elevated TSH with normal T3, T4	ELISA	Prevalence of hypothyroidism, OH and SCH	8
41	Sharma et al⁶², 2019	120	Hospital based	Uttarakhand	Any	Normal range for TSH (0.465-5.68 mIU/ml) and free T4 (10.0-28.2 pmol/L)SCH if elevated TSH and normal Free T4; OH if elevated TSH and decreased free T4	Immunometric assay ECi.	Prevalence of hypothyroidism and fetomaternal outcomes (no classification between SCH or OH)	6
42	Justin et al⁶³, 2020	1500	Hospital based	Kerela	First and Second	As per ATA 2011; Normal range for TSH: first trimester (0.1 to 2.5 mIU/l), second (0.2 to 3.0 mIU/l), third (0.3 to 3.0 mIU/l).	Not specified	Prevalence of hypothyroidism and fetomaternal outcomes (no classification between SCH or OH)	7
43	Mahadik et al⁶⁴, 2020	198	Hospital based	Madhya Pradesh	Third	As per ATA 2017; Normal range for TSH: first trimester (0.1-4.0mIU/L), second (0.2-4.5mIU/L), third (0.3-5mIU/L). Normal free T4 (0.7 to 1.8 ng/dl) and free T3 (1.7 to 4.2 pg/ml)OH if high TSH with low free T4; SCH if high TSH with normal free T4	Chemiluminescence Immunoassay	Prevalence of hypothyroidism, OH and SCH, and fetomaternal outcomes (no classification between SCH or OH)	6
44	Mahajan et al⁶⁵, 2020	514	Hospital based	Maharashtra	Second	As per ATA 2011; The normal range for TSH: first trimester (0.1 to 2.5 mIU/l), second (0.2 to 3.0 mIU/l), third (0.3 to 3.0 mIU/l).	Enzyme Linked Fluorescent Assay	Prevalence of hypothyroidism, OH and SCH, and maternal outcomes in OH and SCH	6
45	Ramachandra et al⁶⁶, 2020	451	Hospital based	Kerela	First and Second	SCH if high TSH and normal free T4; OH if high TSH and low free T4	Not specified	Prevalence of hypothyroidism, OH and SCH	5
46	Gupta et al⁶⁷, 2021	865	Hospital based	Madhya Pradesh	First	As per ATA 2017: Normal range for TSH: first trimester (0.1 to 2.5 mIU/l), second (0.2 to 3.0 mIU/l), third (0.3 to 3.0 mIU/l).SCH if elevated TSH with normal free T3 and T4 levels; OH if elevated TSH with free T3 and T4 levels less than the normal range.	Not specified	Prevalence of hypothyroidism, OH and SCH	5
47	Savitha et al⁶⁸, 2021	491	Hospital based	Karnataka	First	As per ATA and National Guidelines, India (2014);SCH if TSH value>2.5 µIU/ml but ≤10 µIU/ml with normal T4; OH if TSH value>10 µIU/ml irrespective of T4 values and TSH value >2.5 µIU/ml with low T4	Chemiluminescence Immunoassay	Prevalence of hypothyroidism, OH and SCH	8
48	Dash et al⁶⁹, 2022	382	Hospital based	Odisha	Any	As per ATA 2011; The normal range for TSH: first trimester (0.1 to 2.5 mIU/l), second (0.2 to 3.0 mIU/l), third (0.3 to 3.0 mIU/l).SCH if TSH levels higher than the trimester specific level and normal free T4 levels	Chemiluminescence Immunoassay	Prevalence of SCH	4
49	Ashwini et al⁷⁰, 2023	2017	Hospital based	Tamil Nadu	First	SCH if TSH between 2.5 and 10 mIU/l with normal free T4; OH if TSH >3 mIU/l with low free T4 levels or TSH >10 mIU/l irrespective of free T4	Not specified	Prevalence of hypothyroidism and fetomaternal outcomes (no classification between SCH or OH)	7
50	Bankapur et al⁷¹, 2023	427	Hospital based	Karnataka	Third	Hypothyroidism if TSH >3 IU/L.	Not specified	Foetal outcomes among pregnant women with SCH	5
51	Debbarma et al⁷², 2023	772	Hospital based	Rajasthan	Any	As per ATA 2017: Normal range for TSH: first trimester (0.1 to 2.5 mIU/l), second (0.2 to 3.0 mIU/l), third (0.3 to 3.0 mIU/l).Normal free T4 (0.7 to 1.8 ng/dl) and free T3 (1.7 to 4.2 pg/ml)	Chemiluminescence Immunoassay	Prevalence of hypothyroidism, OH and SCH, and fetomaternal outcomes in OH and SCH	7
52	Dhabhai et al⁷, 2023	2317	Community	New Delhi	First and Second	As per National Guidelines, MoHFW, India (2014) Hypothyroidism if TSH >2.5 mIU/mL	Chemiluminescence Immunoassay	Prevalence of hypothyroidism and fetomaternal outcomes (no classification between SCH or OH)	11
53	Kumar et al⁷³, 2023	300	Hospital based	Punjab	Any	As per ATA 2011; The normal range for TSH: first trimester (0.1 to 2.5 mIU/l), second (0.2 to 3.0 mIU/l), third (0.3 to 3.0 mIU/l).SCH if elevated TSH with normal free T3 and T4 levels; OH if elevated TSH with free T3 and T4 levels less than the normal range.	Not specified	Prevalence of hypothyroidism, OH and SCH, and fetomaternal outcomes (no classification between SCH or OH)	8
54	Palepu et al⁷⁴, 2023	436	Hospital based	Odisha	First and Second	As per National Guidelines, MoHFW, India (2014)Hypothyroidism if TSH >2.5 m IU/L in first trimester and >3 m IU/L in second trimester	Not specified	Prevalence of hypothyroidism	5
55	Vaishnav et al⁷⁵, 2023	350	Hospital based	Gujarat	First	As per ATA 2017;Hypothyroidism if TSH >4.0 mIU/L in first trimester; Normal range of free T3 (3.54 to 6.47 pmol/L) and T4 (11.5 to 22.7 pmol/L).SCH if elevated TSH with normal free T3, T4; OH if elevated TSH with low free T3, T4	Chemiluminescence Immunoassay	Prevalence of hypothyroidism, OH and SCH, and fetomaternal outcomes in OH and SCH	7
56	Das et al⁷⁶, 2024	200	Hospital based	West Bengal	First	Normal range for TSH: first trimester (0.2–2.5 IU/L).SCH if TSH > 2.5 IU/L and serum FT4 within the normal range; OH if TSH levels more than 2.5 IU/L and low FT4 (<0.5 ng/dl)	Not specified	Prevalence of SCH and fetomaternal outcomes in SCH	8
57	Khawale et al⁷⁷, 2024	350	Hospital based	Karnataka	First and Second	As per ATA 2017, Hypothyroidism if TSH >4.0 mIU/L; SCH if TSH 2.5-10 mIU/L; OH if TSH >10 mIU/L	Not specified	Prevalence of hypothyroidism, OH and SCH, and fetomaternal outcomes (no classification between SCH or OH)	7
58	Singh et al⁷⁸, 2024	200	Hospital based	Rajasthan	First	As per ATA 2011; Normal range for TSH: first trimester (0.1 to 2.5 mIU/l), second (0.2 to 3.0 mIU/l), third (0.3 to 3.0 mIU/l); Normal free T4 (0.7-1.8 ng/ml)SCH if elevated TSH and normal free T4; OH if elevated TSH with less free T4 than the normal range.	Not specified	Prevalence of hypothyroidism, OH and SCH, and fetomaternal outcomes (no classification between SCH or OH)	6
59	Tejaswi et al⁷⁹, 2024	1272	Hospital based	Andhra Pradesh	Any	SCH if TSH between 4 and 10 mIU/L with normal T4 levels; OH if TSH >10 mIU/L or TSH >4 mIU/L with low T4 levels.	Not specified	Prevalence of hypothyroidism, OH and SCH, and fetomaternal outcomes (no classification between SCH or OH)	2
60	Vamja et al⁸⁰, 2024	500	Hospital based	Gujarat	First and Second	As per ATA 2011; Normal range for TSH (0.1-4.0 µIU/mL) and free T4 (0.7–1.7 ng/dL) OH if TSH >4.0 µIU/mL with free T4<0.7 ng/dL; SCH if TSH >4.0 µIU/mL with normal free T4.	Chemiluminescence Immunoassay	Fetomaternal outcomes among hypothyroid pregnant women (no classification between SCH or OH)	7

The definitions of overall hypothyroidism (elevated TSH), subclinical hypothyroidism (elevated TSH with normal free thyroid hormone), and overt hypothyroidism (elevated TSH with low free thyroid hormone) were consistent among the selected studies; however, the reference cut-offs for TSH and free thyroid hormones (FT4 and FT3) differed across studies. Most studies used trimester-specific TSH cut-offs based on the American Thyroid Association (ATA) 2011 guidelines, while some adopted the updated ATA 2017 criteria.^81,82 Fifteen of the 60 studies applied alternative thresholds, with upper limits for normal TSH varying between 4-10 mIU/L. Of the 32 studies that reported at least one maternal, foetal, or combined foeto-maternal outcome, only 10 studies explicitly described the outcome definitions used. The definitions were largely consistent and followed standard clinical definitions (e.g., IUGR was defined as birth weight less than tenth percentile for gestational age; preterm delivery as delivery before 37 completed weeks of gestation; a low Apgar score as <7 at 1 min; and preeclampsia as persistently elevated blood pressure (systolic >140 mmHg and diastolic pressure >90 mmHg on more than 2 occasions) with proteinuria after 20 weeks’ gestation ( Table).

All 60 studies were assessed for quality. The quality score ranged from 2 to 11, with a median score of 7. Among the studies, 20 studies were high quality (score ≥ 8), 34 studies were moderate quality (score 5-7), and 6 studies were low quality (score ≤ 4) ( Table).

Thyroid dysfunction in pregnant women in India

The pooled prevalence of overall hypothyroidism in pregnant women was 17% [95% (confidence interval) CI: 14%, 19%; I² = 98.4%; N=53]. Pooled prevalence estimates of subclinical and overt hypothyroidism were 15% (95% CI: 12%, 18%, I² = 99.2%; N=47) and 3% (95% CI:3%, 4%, I² = 97.9%; N=42), respectively ( Fig. 2- 4).

Prevalence of hypothyroidism among pregnant women in India.

Prevalence of subclinical hypothyroidism among pregnant women in India.

Prevalence of overt hypothyroidism among pregnant women in India.

Maternal hypothyroidism and pregnancy complications

16 studies (n=1250) documented maternal adverse outcomes in pregnant women having subclinical hypothyroidism, with a pooled prevalence of 9% (95% CI: 6%, 11%; I²=87.3%). The most frequently reported complications were preeclampsia (n=13), abruptio placentae (n=10), postpartum haemorrhage (n=8), abortion (n=8), preterm labour (n=4), pregnancy-induced hypertension (n=4), oligohydramnios (n=4), premature rupture of membranes (n=2), and placenta previa (n=1). The pooled prevalence for specific complications was 22% for pregnancy-induced hypertension (95% CI: 12%, 35%), 14% for preeclampsia (95% CI: 9%, 19%), 12% for preterm labour (95% CI: 6%, 21%), and 7% for abortion (95% CI: 1%, 17%). Other outcomes included 8% for oligohydramnios (95% CI: 4%, 11%), 4% for abruptio placentae (95% CI: 2%, 7%), 5% for premature rupture of membranes (95% CI: 4%, 8%), and 4% for placenta previa (95% CI: 2%, 8%) (Supplementary Fig. 1 and Supplementary Table II).

Supplementary Fig. 1

Download

Supplementary Table II

Download

Twelve studies reported maternal adverse outcomes in pregnant women (n=240) with overt hypothyroidism. The pooled prevalence of adverse maternal outcomes was 12% (95% CI: 10%, 15%; I²=10.4%). The most commonly reported complications were preeclampsia (n=10), abruptio placentae (n=7), postpartum haemorrhage (n=5), and abortion (n=6). Additionally, single studies reported pregnancy-induced hypertension, preterm labour, intrauterine death, and premature rupture of membranes. The pooled prevalence for specific complications was 20% for pregnancy-induced hypertension (95% CI: 8%, 36%), 18% for preeclampsia (95% CI: 13%, 24%), 15% for abortion (95% CI: 4%, 29%), 14% for premature rupture of membranes (95% CI: 6%, 27%), and 14% for preterm labour (95% CI: 3%, 30%). Other outcomes included 10% for abruptio placentae (95% CI: 5%, 16%), and 7% for postpartum haemorrhage (95% CI: 3%, 14%) (Supplementary Fig. 2 and Supplementary Table III).

Supplementary Fig. 2

Download

Supplementary Table III

Download

Maternal hypothyroidism and adverse birth outcomes

Sixteen studies (n=1240) reported adverse foetal outcomes in women having subclinical hypothyroidism. The overall pooled prevalence of foeto-maternal outcomes was 11% (95% CI: 9%, 14%; I² = 87.2%). The most frequently reported complications were IUGR (n=13), low birth weight (n=12), preterm birth (n=10), NICU admission (n=6), intra-uterine death (n=6), foetal distress (n=3), stillbirth (n=4), congenital anomaly (n=2), intra-uterine death and stillbirth (n=1), low APGAR score (n=2), sepsis (n=1). The pooled prevalence for specific complications was 18% for preterm birth (95% CI: 11%, 25%), 17% for low birth weight (95% CI: 10%, 25%), 13% for foetal distress (95% CI: 4%, 26%), 11% for IUGR (95% CI: 6%, 17%), 11% for low APGAR score (95% CI: 6%, 16%), 9% for NICU admission (95% CI: 3%, 17%), and 7% for intra-uterine death (95% CI: 2%, 14%). Other outcomes included 13% prevalence of sepsis (95% CI: 5%, 30%), 4% for intra-uterine death and stillbirth (95% CI: 2%, 8%), 2% for stillbirth (95% CI: 0%, 4%), and 1% for congenital anomaly (95% CI: 0%, 2%) (Supplementary Fig. 3 and Supplementary Table II).

Supplementary Fig. 3

Download

Eleven studies reported adverse foetal outcomes in women with overt hypothyroidism during pregnancy (n=243). The overall pooled prevalence of adverse foetal outcomes was 14% (95% CI: 11%, 17%; I² = 26.6%). The most frequently reported complications were IUGR (n=9), low birth weight (n=9), preterm birth (n=7), NICU admission (n=4), intra-uterine death (n=3), and stillbirth (n=4). Additionally, single studies reported congenital anomaly and low APGAR score, respectively. The pooled prevalence for specific complications was 22% for low birth weight (95% CI: 13%, 31%), 16% for preterm birth (95% CI: 9%, 24%), 16% for intrauterine death (95% CI: 7%, 27%), 14% for IUGR (95% CI: 9%, 20%), 10% for NICU admission (95% CI: 3%, 19%), and 6% for stillbirth (95% CI: 1%, 13%) (Supplementary Fig. 4 and Supplementary Table III).

Supplementary Fig. 4

Download

Meta regression analysis

A random-effects meta-regression including various study-level covariates such as definition used for hypothyroidism, trimester of assessment, laboratory method, study design, region, and year of publication explained 23.5% of the between-study variability (Wald χ² (6) = 20.42, P< 0.001). Study design, study setting, and year of publication were significantly associated with prevalence. Variables, including definitions, trimester, and laboratory method, were not statistically significant predictors. Despite adjustment for these factors, residual heterogeneity remained extremely high (I²=97.7%), suggesting that much of the variability likely to arise from unmeasured or unreported study characteristics (Supplementary Fig. 5).

Supplementary Fig. 5

Download

Sensitivity analysis was performed by removing lower-quality studies. The estimated pooled prevalence was 17% (95% CI: 14%, 19%; I² = 98.1%; N=49) after omitting studies with a quality score less than six on JBI criteria for all study designs (Supplementary Fig. 6).

Supplementary Fig. 6

Download

Leave-one-out analysis was performed to assess the influence of the single study on the pooled estimate. The exclusion of individual studies did not lead to meaningful changes in effect sizes, which consistently ranged around 16 to 17% with a very narrow 95% confidence interval ranging between 14% and 19% (Supplementary Fig. 7).

Supplementary Fig. 7

Download

Publication bias

Asymmetry was visible upon visual inspection of the funnel plot, indicating that the pooled estimate of hypothyroidism prevalence may have been skewed by publications (Supplementary Fig. 8A and 8B). Trim-and-fill analysis also indicated publication bias. Both Egger’s (P=0.51) and Begg’s (P=0.53) tests showed no statistically significant evidence of bias.

Supplementary Fig. 8

Download

Discussion

The present systematic review and meta-analysis, synthesising data from 60 studies across India, reveals a high prevalence of hypothyroidism among pregnant women, with pooled estimates of 17% for overall hypothyroidism, 15% for subclinical, and 3% for overt. These estimates are considerably higher than those reported in the previous meta-analysis by Yadav et al⁶, which found the prevalence of hypothyroidism to be around 11.1% (9.5% subclinical, 2.7% overt) in Indian pregnant women based on studies published up to 2019.⁶ In Yadav et al⁶ review, 26 of the studies contributing to prevalence estimates did not exclude women with a prior diagnosis of hypothyroidism, whereas the present review excluded such studies, thereby restricting the estimates to cases identified during pregnancy. This methodological difference may have influenced the observed prevalence, distinguishing it from earlier reviews that incorporated both previously diagnosed and newly detected cases.

In the Horn of Africa, the prevalence was 10% (95% CI: 4%, 16%) based on data from 2000 to 2023.¹ Among pregnant Arab women, the estimated pooled prevalence of subclinical was 20% (95% CI: 14%, 28%), overt was 3% (95% CI: 1%, 8%), and unspecified hypothyroidism was 27% (95% CI: 10%, 45%).² In the Middle East, pooled prevalence among adults was 7.2% (overt) and 8.3% (subclinical) between 2000 and 2021.³ A meta-analysis in European adults, based on studies between 1975 to 2012, had reported a lower prevalence of 3.1% (95% CI: 3.0%, 3.1%).⁴ Hypothyroidism prevalence is consistently higher in women than in men across all settings, with rising trends observed globally over time.^1-3,6

As shown in our study, previous studies have also confirmed the association between hypothyroidism and adverse outcomes.^5,8,83 A systematic review showed that compared with euthyroid pregnant women, those with Subclinical hypothyroidism had significantly higher risks of pregnancy loss, placental abruption, premature rupture of membranes, and neonatal death.⁵ The North Denmark Region Pregnancy Cohort (2011−2015), which included 14,744 singleton pregnancies, reported significantly higher frequencies of spontaneous abortion and preterm birth among those with TSH >10 mIU/L.⁸

Several questions regarding the care of pregnant women with thyroid disorders remain unanswered in the Indian context. The debate over universal screening continues, with most of the guidelines recommending screening of high-risk pregnant women. India currently lacks trimester-specific, population-based TSH reference ranges, with most studies using ATA guidelines and applying variable cut-offs.^81,82,84 This inconsistency complicates diagnosis and prevalence estimates.

This review has a few limitations. Most included studies were hospital-based, which limits generalisability to the wider population. Variability in TSH thresholds, laboratory method used for assessment, study settings, trimester, and population across studies may have introduced heterogeneity.⁸⁵ In addition, the lack of uniform reporting of key sociodemographic characteristics at the study level restricted our ability to further explore potential sources of heterogeneity through subgroup analyses. Although publication bias could not be confirmed statistically, it cannot be entirely ruled out. This review provides a comprehensive synthesis of the prevalence of hypothyroidism among pregnant women and associated adverse outcomes in the Indian context. It covers both subclinical and overt hypothyroidism, presents detailed outcome breakdowns, and includes subgroup and sensitivity analyses to support its robustness.

The rising burden and adverse consequences of hypothyroidism in pregnancy demand urgent attention. Uniform, evidence-based screening and management practices must be implemented at all levels of care. There is a pressing need for India-specific diagnostic cut-offs and large-scale prospective studies to inform treatment thresholds and long-term outcomes. Additionally, a comprehensive care package needs to be developed and evaluated that not only addresses TSH levels but also coexisting co-morbidities linked to hypothyroidism. Only through a multifaceted, context-specific strategy can we ensure optimal maternal and foetal health outcomes in hypothyroid pregnancies.

Author contributions

TL, SM: Conceptualised the study; SM, VK, MZ: Literature search, study selection, data extraction, and data curation; SM, MZ: Formal analysis and prepared the visualisations; SM, VK, MZ, TL, RM: Manuscript writing; TL, RM, BK: Supervised the overall work. All authors have read and approved the final printed version of the manuscript.

Financial support and sponsorship

None.

Conflicts of Interest

None.

Use of Artificial Intelligence (AI)-Assisted Technology for manuscript preparation

The authors confirm that there was no use of AI-assisted technology for assisting in the writing of the manuscript and no images were manipulated using AI.

References

Nigatie M, Kumie G, Jemal A, Gedfie S, Kassahun W, Gashaw M, et al. Prevalence of thyroid dysfunction among pregnant women in the horn of Africa: A systematic review and Meta-analysis. Endocr Metab Sci.. 2024;16:100200.
[CrossRef] [Google Scholar]
Aamir AB, Latif R, Alqudihi HH, Zedan RA, Hunachagi S. Prevalence of thyroid disorders in pregnant Arab women: A systematic review and meta-analysis. J Family Community Med.. 2025;32:91-100.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Kargar S, Tabatabaei SM, Okati-Aliabad H, Rad HI. Prevalence of thyroid dysfunction disorders among adult populations in the middle–east: A systematic review and meta-analysis. Open Public Health J.. 2024;17:e18749445317174.
[Google Scholar]
Garmendia Madariaga A, Santos Palacios S, Guillén-Grima F, Galofré JC. The incidence and prevalence of thyroid dysfunction in Europe: A meta-analysis. J Clin Endocrinol Metab.. 2014;99:923-31.
[CrossRef] [PubMed] [Google Scholar]
Maraka S, Ospina NMS, O’Keeffe DT, Espinosa De Ycaza AE, Gionfriddo MR, et al. Subclinical hypothyroidism in pregnancy: A systematic review and meta-analysis. Thyroid.. 2016;26:580-90.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Yadav V, Dabar D, Goel AD, Bairwa M, Sood A, Prasad P, et al. Prevalence of hypothyroidism in pregnant women in India: A meta-analysis of observational studies. J Thyroid Res.. 2021;2021:5515831.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Dhabhai N, Chowdhury R, Virmani A, Chaudhary R, Taneja S, Mittal P, et al. Burden, risk factors and outcomes associated with adequately treated hypothyroidism in a population-based cohort of pregnant women from North India. PLoS One.. 2023;18:e0282381.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Knøsgaard L, Andersen S, Hansen AB, Vestergaard P, Andersen SL. Maternal hypothyroidism and adverse outcomes of pregnancy. Clin Endocrinol (Oxf).. 2023;98:719-29.
[CrossRef] [PubMed] [Google Scholar]
Wang J, Gong XH, Peng T, Wu JN. Association of thyroid function during pregnancy with the risk of pre-eclampsia and gestational diabetes mellitus. Endocr Pract.. 2021;27:819-25.
[CrossRef] [PubMed] [Google Scholar]
Abadi KK, Jama AH, Legesse AY, Gebremichael AK. Prevalence of hypothyroidism in pregnancy and its associations with adverse pregnancy outcomes among pregnant women in a general hospital: A cross-sectional study. Int J Womens Health.. 2023;15:1481-90.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Carney LA, Quinlan JD, West JM. Thyroid disease in pregnancy. Am Fam Physician.. 2014;89:273-8.
[PubMed] [Google Scholar]
Nazarpour S, Ramezani Tehrani F, Simbar M, Azizi F. Thyroid dysfunction and pregnancy outcomes. Iran J Reprod Med.. 2015;13:387-96.
[PubMed] [PubMed Central] [Google Scholar]
Shulhai AM, Rotondo R, Petraroli M, Patianna V, Predieri B, Iughetti L, et al. The role of nutrition on thyroid function. Nutrients.. 2024;16:2496.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Garofalo V, Condorelli RA, Cannarella R, Aversa A, Calogero AE, La Vignera S. Relationship between iron deficiency and thyroid function: A systematic review and meta-analysis. Nutrients.. 2023;15:4790.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Wang F, Li C, Li S, Cui L, Zhao J, Liao L. Selenium and thyroid diseases. Front Endocrinol (Lausanne).. 2023;14:1133000.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Luo J, Wang X, Yuan L, Guo L. Iron deficiency, a risk factor of thyroid disorders in reproductive-age and pregnant women: A systematic review and meta-analysis. Front Endocrinol (Lausanne).. 2021;12:629831.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Du X, Wu Y, Tao G, Xu J, Du Z, Wu M, et al. Association between PFAS exposure and thyroid health: A systematic review and meta-analysis for adolescents, pregnant women, adults and toxicological evidence. Sci Total Environ.. 2024;953:175958.
[CrossRef] [PubMed] [Google Scholar]
Rayyan—a web and mobile app for systematic reviews | Systematic Reviews. Available from: https://link.springer.com/article/10.1186/s13643-016-0384-4, accessed on December 12, 2025.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ.. 2021;372:n71.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C.. Chapter 5: Systematic reviews of prevalence and incidence. In: JBI reviewer’s manual. JBI; 2019.
[Google Scholar]
Moola S, Munn Z, Sears K, Sfetcu R, Currie M, Lisy K, et al. Conducting systematic reviews of association (etiology) The Joanna Briggs institute’s approach. Int J Evid Based Healthc.. 2015;13:163-9.
[CrossRef] [PubMed] [Google Scholar]
Marwaha RK, Chopra S, Gopalakrishnan S, Sharma B, Kanwar RS, Sastry A, et al. Establishment of reference range for thyroid hormones in normal pregnant Indian women. BJOG.. 2008;115:602-6.
[CrossRef] [PubMed] [Google Scholar]
Sahu MT, Das V, Mittal S, Agarwal A, Sahu M. Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome. Arch Gynecol Obstet.. 2010;281:215-20.
[CrossRef] [PubMed] [Google Scholar]
Nambiar V, Jagtap VS, Sarathi V, Lila AR, Kamalanathan S, Bandgar TR, et al. Prevalence and impact of thyroid disorders on maternal outcome in asian-Indian pregnant women. J Thyroid Res.. 2011;2011:429097.
[CrossRef] [PubMed] [Google Scholar]
Dhanwal DK, Prasad S, Agarwal AK, Dixit V, Banerjee AK. High prevalence of subclinical hypothyroidism during first trimester of pregnancy in North India. Indian J Endocrinol Metab.. 2013;17:281-4.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Konin S, Bhinder G. Detection of thyroid functions in early pregnancy as a universal screening. J Evol Med Dent Sci.. 2013;2:9457-65.
[CrossRef] [Google Scholar]
Ajmani SN, Aggarwal D, Bhatia P, Sharma M, Sarabhai V, Paul M. Prevalence of overt and subclinical thyroid dysfunction among pregnant women and its effect on maternal and fetal outcome. J Obstet Gynaecol India.. 2014;64:105-10.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Jaiswal N, Melse-Boonstra A, Thomas T, Basavaraj C, Sharma SK, Srinivasan K, et al. High prevalence of maternal hypothyroidism despite adequate iodine status in Indian pregnant women in the first trimester. Thyroid.. 2014;24:1419-29.
[CrossRef] [PubMed] [Google Scholar]
Nabhi VRM, Bhashyakarla U. Prevalence of thyroid dysfunction among pregnant women in a rural teaching hospital in Telengana, South India. SJAMS.. 2014;2:2022-5.
[Google Scholar]
Rupali M, Dilip K, Santanu B, Amitava P, Tapak KM. Subclinical hypothyroidism and its effect on pregnancy outcome. Int J Obstetrics Gynaecol Res (IJOGR). 2014:112-21.
[Google Scholar]
Bose A, Soni N, Dashore N, Gajria K, Jhamad S, Hemvani N, et al. An enumeration of the prevalence of hypothyroidism during pregnancy in central India. Clin Epidemiology Glob Health.. 2015;3:S34-7.
[CrossRef] [Google Scholar]
Kishore R, Mishra N, Yadav J. Hypothyroidism in pregnancy and its impact on maternal and fetal outcome. J Evol Med Dent Sci.. 2015;4:13849-55.
[CrossRef] [Google Scholar]
Murty N, B U, JM R, K S, K V, G V. High prevalence of subclinical hypothyroidism in pregnant women in South India. Int J Reprod Contracept Obstet Gynecol.. 2015;4:453-6.
[CrossRef] [Google Scholar]
Padmavathi K, Prsanna C. Incidence of hypothyroidism in antenatal women with maternal and perinatal outcome. IOSR J Dent Med Sciences.. 2015;14:14-8.
[Google Scholar]
Pavanaganga A, Rekha BR, Sailakshmi MPA, Nagarathnamma R. Observational study of subclinical hypothyroidism in pregnancy. Ind Jour of Obstet and Gyn Res.. 2015;2:255-60.
[CrossRef] [Google Scholar]
Rajput R, Goel V, Nanda S, Rajput M, Seth S. Prevalence of thyroid dysfunction among women during the first trimester of pregnancy at a tertiary care hospital in Haryana. Indian J Endocrinol Metab.. 2015;19:416-9.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Singh K, Singh H, Kamei H, Devi L. Prevalence of hypothyroidism among pregnant women in the sub mountain state of Manipur. Int J Sci Study.. 2015;3:143-46.
[Google Scholar]
Begum DF. Thyroid dysfunction and pregnancy outcome. IOSR.. 2016;15:07-10.
[CrossRef] [Google Scholar]
Dhanwal DK, Bajaj S, Rajput R, Subramaniam KA, Chowdhury S, Bhandari R, et al. Prevalence of hypothyroidism in pregnancy: An epidemiological study from 11 cities in 9 states of India. Indian J Endocrinol Metab.. 2016;20:387-90.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Mandal RC, Bhar D, Das A, Basunia SR, Kundu SB, Mahapatra C. Subclinical hypothyroidism in pregnancy: An emerging problem in southern West Bengal: A cross-sectional study. J Nat Sci Biol Med.. 2016;7:80-4.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Saraladevi R, Nirmala Kumari T, Shreen B, Usha Rani V. Prevalence of thyroid disorder in pregnancy and pregnancy outcome. IMSEAR.. 2016;3:1-11.
[Google Scholar]
Shivanagappa M, Mahadevaiah M, Rao G, Kondareddy T. Profile and feto-maternal outcomes of pregnant women with thyroid dysfunction: A prospective study from South India. Int J Reprod Contracept Obstet Gynecol.. 2016;5:4132-5.
[CrossRef] [Google Scholar]
Singh G, Kaul I, Singh A. Pregnancy outcome in overt hypothyroidism. Int J Res Med Sci.. 2016;4:3997-4000.
[CrossRef] [Google Scholar]
Tiwari D, Ruchika G, Anchal, Rani R. Prevalence of overt and subclinical hypothyroidism among Indian pregnant women and its effect on foetomaternal outcome. J Evolution Med Dent Sci.. 2016;5:3342-47.
[CrossRef] [Google Scholar]
Dubey S, Pradhan A. Thyroid disorder in antenatal women in sub-himalayan region: A need for universal screening. Int J Reprod Contracept Obstet Gynecol.. 2017;6:3445.
[CrossRef] [Google Scholar]
Gedam JK, Rajput DA. Prevalence of thyroid disorders among patients attending the antenatal clinic at tertiary care centre, Parel, Mumbai, India. Int J Reprod Contracept Obstet Gynecol.. 2017;6:1235-40.
[CrossRef] [Google Scholar]
Indira G, Narasinga Rao T, Premavardhini Y. Prevalence of thyroid disorders in pregnancy at a teaching hospital. Jebmh.. 2017;4:64-70.
[CrossRef] [Google Scholar]
Pokhanna J, Gupta U, Alwani M, Tiwari SP. Prevalence of thyroid dysfunction and impact on maternal and fetal outcome in central Indian pregnant women. Int J Reprod Contracept Obstet Gynecol.. 2017;6:4666.
[CrossRef] [Google Scholar]
Sannaboraiah A, Upadhyaya R, Garag S, Krishnappa S. Subclinical hypothyroidism in pregnancy and outcomes. Int J Reprod Contracept Obstet Gynecol.. 2017;6:1215-21.
[CrossRef] [Google Scholar]
Devi PU, Vanaja G. Maternal and perinatal outcome in antenatal women with hypothyroidism. IAIM.. 2017;4:199-207.
[Google Scholar]
Bansal A, Saxena M, Bansal M. Study on prevalence of hypothyroidism in pregnancy in rural population of Pilkhuwa, Hapur, U.P. Indian J Obstet Gynecol Res.. 2025;5:82-5.
[Google Scholar]
Gupta R, Agarwal S, Pandey K, Gupta N, Jahan U, Rao YK, et al. A clinical study on thyroid dysfunctions in pregnancy and its effect on maternal and neonatal outcome. Jemds.. 2018;7:1520-3.
[CrossRef] [Google Scholar]
Hymavathi K, Gottipati MD, Jakka T, C. BT. Routine screening of antenatal population for thyroid disorders-mandatory. Int J Reprod Contracept Obstet Gynecol.. 2018;7:2834.
[Google Scholar]
Korde VR, Barse SP, Barla JS. Prevalence of thyroid dysfunctions in pregnant women: A prospective study in a tertiary care hospital in Maharashtra, India. Int J Reprod Contracept Obstet Gynecol.. 2018;7:3211-5.
[CrossRef] [Google Scholar]
Ananda Kumari M, Venkataramana K, Padma Leela K, Aafreen S, Amrin A. Prevalence of thyroid dysfunction among antenatal women in a teaching hospital. JEMDS.. 2018;7:441-5.
[CrossRef] [Google Scholar]
Kumari A, Srivastav R, Mitra S. Prevalence of thyroid dysfunction and its effects on fetomaternal outcome in pregnant women of Eastern Uttar Pradesh, India. Int J Reprod Contracept Obstet Gynecol.. 2018;7:4379.
[CrossRef] [Google Scholar]
Pahwa S, Mangat S. Prevalence of thyroid disorders in pregnancy. Int J Reprod Contracept Obstet Gynecol.. 2018;7:3493-6.
[CrossRef] [Google Scholar]
Panda J, Maji A, Mishra J, Manjareeka M. Thyroid disorders in pregnancy: An exploratory study. Journal of Clinical and Diagnostic Research.. 2018;12:QC09-QC12.
[CrossRef] [Google Scholar]
Pillai NS, Bennet J. Prevalence of hypothyroidism amongst pregnant women: A study done in rural set up. Int J Reprod Contracept Obstet Gynecol.. 2018;7:1586.
[CrossRef] [Google Scholar]
Agrawal P, Mehta S, Gupta M, Khare P. Prevalence of hypothyroidism in the first trimester pregnancy in primigravida in North India. IJOGR.. 2019;6:68-70.
[CrossRef] [Google Scholar]
Diyora V, Shah T, Mishra MK. Thyroid dysfunction in women during first trimester of pregnancy: Correlation with anti-thyroid peroxidase antibodies; Sch Int J Biochem. 2019. ;2:36-9.
[Google Scholar]
Sharma D, Dixit PV, Gavit Y. Maternal and perinatal outcome in hypothyroidism in pregnancy: A prospective observational study. Int J Reprod Contracept Obstet Gynecol.. 2017;6:5548.
[CrossRef] [Google Scholar]
Justin SA, Johnson MS. A prospective study on evaluation of maternal and foetal outcomes of hypothyroidism with levothyroxine and prevalence of hypothyroidism in pregnancy in a tertiary care teaching hospital in Kerala. Int J Basic Clin Pharmacol.. 2020;9:392-8.
[CrossRef] [Google Scholar]
Mahadik K, Choudhary P, Roy PK. Study of thyroid function in pregnancy, its feto-maternal outcome: A Prospective Observational Study. 2020. ;20:769.
[Google Scholar]
Mahajan K, Mahajan S. Study of thyroid disorders on maternal outcome in a rural tertiary care hospital. Pravara Med Rev.. 2020;12:67-72.
[Google Scholar]
Ramachandra K, Gilyaru S, Eregowda A, Yathiraja S. Prevalence of refractive error and the eye morbidity in school children in Bangalore, India. Int J Contemp Pediatr.. 2016;3:138-41.
[CrossRef] [Google Scholar]
Gupta P, Jain M, Verma V, Gupta NK. The study of prevalence and pattern of thyroid disorder in pregnant women: A prospective study. Cureus.. 2021;13:e16457.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
V S, S M, B M, M M. Prevalence of thyroid dysfunction among pregnant women in first trimester: A hospital-based study from Mysuru, South India. IJCRR.. 2021;13:127-33.
[CrossRef] [Google Scholar]
Dash P, Tiwari R, Nayak S, Jena SK, Mangaraj M. Prevalence of subclinical hypothyroidism in pregnancy and its association with anti-thyroperoxidase antibody and the occurrence of gestational diabetes mellitus. Cureus.. 2022;14:e21087.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
R A, Kandasamy V, R S. Prevalence of hypothyroidism in first trimester screening and its association with maternal and foetal outcomes. Int J Reprod Contracept Obstet Gynecol.. 2023;12:2721-5.
[CrossRef] [Google Scholar]
Bankapur DG, Yaliwal DRG, Bidri DSR, Kori DSS, Patil DNG, Shettar DSSK. Effect of maternal hypothyroidism on obstetric and perinatal outcome, an observational study. Int J Clin Obstet Gynaecol.. 2023;7:17-22.
[CrossRef] [Google Scholar]
Debbarma R, Gothwal M, Singh P, Yadav G, Purohit P, Ghuman NK, et al. The spectrum of thyroid dysfunction during pregnancy and fetomaternal outcome, a study from the premier institute of western India. Indian J Community Med.. 2024;49:734-8.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Kumar R, Bansal R, Shergill HK, Garg P. Prevalence of thyroid dysfunction in pregnancy and its association with feto-maternal outcomes: A prospective observational study from a tertiary care institute in Northern India. Clin Epidemiology Glob Health.. 2023;19:101201.
[CrossRef] [Google Scholar]
Palepu S, Singh AK, Saharia GK, Patra S, Singh S, Taywade M, et al. Hypothyroidism in Pregnancy: An alarming concern in a rural community of eastern India. Indian J Community Med.. 2023;48:187-9.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Vaishnav S, Pandya D, Shrivastava R, Patel N, Phatak AG, Patel A. Early treatment will prevent feto-maternal complications in thyroid disorders during pregnancy: A prospective study. J Family Med Prim Care.. 2023;12:3393-8.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Das T, Das N, Bhowmick S, Biswas A. Prevalence and feto-maternal outcomes of subclinical hypothyroidism in pregnancy among mothers attending a tertiary care hospital of Darjeeling District, West Bengal, India. Asian J Med Sci.. 2024;15:123-8.
[CrossRef] [Google Scholar]
Khawale R, Kanetkar SR, Patil M. Impact of hypothyroidism in pregnancy on feto-maternal outcomes: A Prospective observational study. Cureus.. 2024;16:e74494.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Singh A, Prasad S, Prasad SG. Prevalence of hypothyroidism in pregnancy it’s impact on pregnancy outcome in a tertiary care center in Western Rajasthan: A prospective study. Int J Pharm Clin Res.. 2024;16:143-7.
[Google Scholar]
Tejaswi A, Bharti MR, Boddu D, Devyani, Nihal A, Penugonda V. Prospective observational study on prevalence and treatment pattern of hypothyroidism during pregnancy: Research article. J Pharma Insights Res.. 2024;2:199-206.
[Google Scholar]
Vamja R, M Y, Patel M, Vala V, Ramachandran A, Surati B, et al. Impact of maternal thyroid dysfunction on fetal and maternal outcomes in pregnancy: A prospective cohort study. Clin Diabetes Endocrinol.. 2024;10:50.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid.. 2011;21:1081-125.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 Guidelines of the American thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid.. 2017;27:315-89.
[CrossRef] [PubMed] [Google Scholar]
Siscart J, Perejón D, Serna MC, Oros M, Godoy P, Sole E. Prevalence, risk factors, and consequences of hypothyroidism among pregnant women in the health region of Lleida: A cohort study. PLoS One.. 2023;18:e0278426.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Natonal Health Mission. Ministry of Health & family Welfare, Government of India. National guidelines for screening of hypothyroidism during pregnancy. Available from: https://nhm.gov.in/images/pdf/programmes/maternal-health/guidelines/National_Guidelines_for_Screening_of_Hypothyroidism_during_Pregnancy.pdf, accessed on January 5, 2026.
Metelli S, Chaimani A. Challenges in meta-analyses with observational studies. Evid Based Ment Health.. 2020;23:83-7.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

Methods

Search strategy
Selection criteria
Screening and data extraction
Quality assessment
Data synthesis and management

Results

Thyroid dysfunction in pregnant women in India
Maternal hypothyroidism and pregnancy complications
Maternal hypothyroidism and adverse birth outcomes
Meta regression analysis
Publication bias

Discussion

Fulltext Views
1,540

PDF downloads
870

View/Download PDF
Download Citations

BibTeX
RIS

Show Sections

[1] Nigatie M, Kumie G, Jemal A, Gedfie S, Kassahun W, Gashaw M, et al. Prevalence of thyroid dysfunction among pregnant women in the horn of Africa: A systematic review and Meta-analysis. Endocr Metab Sci.. 2024;16:100200.
[CrossRef] [Google Scholar]

[2] Aamir AB, Latif R, Alqudihi HH, Zedan RA, Hunachagi S. Prevalence of thyroid disorders in pregnant Arab women: A systematic review and meta-analysis. J Family Community Med.. 2025;32:91-100.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[3] Kargar S, Tabatabaei SM, Okati-Aliabad H, Rad HI. Prevalence of thyroid dysfunction disorders among adult populations in the middle–east: A systematic review and meta-analysis. Open Public Health J.. 2024;17:e18749445317174.
[Google Scholar]

[4] Garmendia Madariaga A, Santos Palacios S, Guillén-Grima F, Galofré JC. The incidence and prevalence of thyroid dysfunction in Europe: A meta-analysis. J Clin Endocrinol Metab.. 2014;99:923-31.
[CrossRef] [PubMed] [Google Scholar]

[5] Maraka S, Ospina NMS, O’Keeffe DT, Espinosa De Ycaza AE, Gionfriddo MR, et al. Subclinical hypothyroidism in pregnancy: A systematic review and meta-analysis. Thyroid.. 2016;26:580-90.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[6] Yadav V, Dabar D, Goel AD, Bairwa M, Sood A, Prasad P, et al. Prevalence of hypothyroidism in pregnant women in India: A meta-analysis of observational studies. J Thyroid Res.. 2021;2021:5515831.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[7] Dhabhai N, Chowdhury R, Virmani A, Chaudhary R, Taneja S, Mittal P, et al. Burden, risk factors and outcomes associated with adequately treated hypothyroidism in a population-based cohort of pregnant women from North India. PLoS One.. 2023;18:e0282381.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[8] Knøsgaard L, Andersen S, Hansen AB, Vestergaard P, Andersen SL. Maternal hypothyroidism and adverse outcomes of pregnancy. Clin Endocrinol (Oxf).. 2023;98:719-29.
[CrossRef] [PubMed] [Google Scholar]

[9] Wang J, Gong XH, Peng T, Wu JN. Association of thyroid function during pregnancy with the risk of pre-eclampsia and gestational diabetes mellitus. Endocr Pract.. 2021;27:819-25.
[CrossRef] [PubMed] [Google Scholar]

[10] Abadi KK, Jama AH, Legesse AY, Gebremichael AK. Prevalence of hypothyroidism in pregnancy and its associations with adverse pregnancy outcomes among pregnant women in a general hospital: A cross-sectional study. Int J Womens Health.. 2023;15:1481-90.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[11] Carney LA, Quinlan JD, West JM. Thyroid disease in pregnancy. Am Fam Physician.. 2014;89:273-8.
[PubMed] [Google Scholar]

[12] Nazarpour S, Ramezani Tehrani F, Simbar M, Azizi F. Thyroid dysfunction and pregnancy outcomes. Iran J Reprod Med.. 2015;13:387-96.
[PubMed] [PubMed Central] [Google Scholar]

[13] Shulhai AM, Rotondo R, Petraroli M, Patianna V, Predieri B, Iughetti L, et al. The role of nutrition on thyroid function. Nutrients.. 2024;16:2496.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[14] Garofalo V, Condorelli RA, Cannarella R, Aversa A, Calogero AE, La Vignera S. Relationship between iron deficiency and thyroid function: A systematic review and meta-analysis. Nutrients.. 2023;15:4790.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[15] Wang F, Li C, Li S, Cui L, Zhao J, Liao L. Selenium and thyroid diseases. Front Endocrinol (Lausanne).. 2023;14:1133000.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[16] Luo J, Wang X, Yuan L, Guo L. Iron deficiency, a risk factor of thyroid disorders in reproductive-age and pregnant women: A systematic review and meta-analysis. Front Endocrinol (Lausanne).. 2021;12:629831.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[17] Du X, Wu Y, Tao G, Xu J, Du Z, Wu M, et al. Association between PFAS exposure and thyroid health: A systematic review and meta-analysis for adolescents, pregnant women, adults and toxicological evidence. Sci Total Environ.. 2024;953:175958.
[CrossRef] [PubMed] [Google Scholar]

[18] Rayyan—a web and mobile app for systematic reviews | Systematic Reviews. Available from: https://link.springer.com/article/10.1186/s13643-016-0384-4, accessed on December 12, 2025.

[19] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ.. 2021;372:n71.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[20] Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C.. Chapter 5: Systematic reviews of prevalence and incidence. In: JBI reviewer’s manual. JBI; 2019.
[Google Scholar]

[21] Moola S, Munn Z, Sears K, Sfetcu R, Currie M, Lisy K, et al. Conducting systematic reviews of association (etiology) The Joanna Briggs institute’s approach. Int J Evid Based Healthc.. 2015;13:163-9.
[CrossRef] [PubMed] [Google Scholar]

[22] Marwaha RK, Chopra S, Gopalakrishnan S, Sharma B, Kanwar RS, Sastry A, et al. Establishment of reference range for thyroid hormones in normal pregnant Indian women. BJOG.. 2008;115:602-6.
[CrossRef] [PubMed] [Google Scholar]

[23] Sahu MT, Das V, Mittal S, Agarwal A, Sahu M. Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome. Arch Gynecol Obstet.. 2010;281:215-20.
[CrossRef] [PubMed] [Google Scholar]

[24] Nambiar V, Jagtap VS, Sarathi V, Lila AR, Kamalanathan S, Bandgar TR, et al. Prevalence and impact of thyroid disorders on maternal outcome in asian-Indian pregnant women. J Thyroid Res.. 2011;2011:429097.
[CrossRef] [PubMed] [Google Scholar]

[25] Dhanwal DK, Prasad S, Agarwal AK, Dixit V, Banerjee AK. High prevalence of subclinical hypothyroidism during first trimester of pregnancy in North India. Indian J Endocrinol Metab.. 2013;17:281-4.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[26] Konin S, Bhinder G. Detection of thyroid functions in early pregnancy as a universal screening. J Evol Med Dent Sci.. 2013;2:9457-65.
[CrossRef] [Google Scholar]

[27] Ajmani SN, Aggarwal D, Bhatia P, Sharma M, Sarabhai V, Paul M. Prevalence of overt and subclinical thyroid dysfunction among pregnant women and its effect on maternal and fetal outcome. J Obstet Gynaecol India.. 2014;64:105-10.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[28] Jaiswal N, Melse-Boonstra A, Thomas T, Basavaraj C, Sharma SK, Srinivasan K, et al. High prevalence of maternal hypothyroidism despite adequate iodine status in Indian pregnant women in the first trimester. Thyroid.. 2014;24:1419-29.
[CrossRef] [PubMed] [Google Scholar]

[29] Nabhi VRM, Bhashyakarla U. Prevalence of thyroid dysfunction among pregnant women in a rural teaching hospital in Telengana, South India. SJAMS.. 2014;2:2022-5.
[Google Scholar]

[30] Rupali M, Dilip K, Santanu B, Amitava P, Tapak KM. Subclinical hypothyroidism and its effect on pregnancy outcome. Int J Obstetrics Gynaecol Res (IJOGR). 2014:112-21.
[Google Scholar]

[31] Bose A, Soni N, Dashore N, Gajria K, Jhamad S, Hemvani N, et al. An enumeration of the prevalence of hypothyroidism during pregnancy in central India. Clin Epidemiology Glob Health.. 2015;3:S34-7.
[CrossRef] [Google Scholar]

[32] Kishore R, Mishra N, Yadav J. Hypothyroidism in pregnancy and its impact on maternal and fetal outcome. J Evol Med Dent Sci.. 2015;4:13849-55.
[CrossRef] [Google Scholar]

[33] Murty N, B U, JM R, K S, K V, G V. High prevalence of subclinical hypothyroidism in pregnant women in South India. Int J Reprod Contracept Obstet Gynecol.. 2015;4:453-6.
[CrossRef] [Google Scholar]

[34] Padmavathi K, Prsanna C. Incidence of hypothyroidism in antenatal women with maternal and perinatal outcome. IOSR J Dent Med Sciences.. 2015;14:14-8.
[Google Scholar]

[35] Pavanaganga A, Rekha BR, Sailakshmi MPA, Nagarathnamma R. Observational study of subclinical hypothyroidism in pregnancy. Ind Jour of Obstet and Gyn Res.. 2015;2:255-60.
[CrossRef] [Google Scholar]

[36] Rajput R, Goel V, Nanda S, Rajput M, Seth S. Prevalence of thyroid dysfunction among women during the first trimester of pregnancy at a tertiary care hospital in Haryana. Indian J Endocrinol Metab.. 2015;19:416-9.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[37] Singh K, Singh H, Kamei H, Devi L. Prevalence of hypothyroidism among pregnant women in the sub mountain state of Manipur. Int J Sci Study.. 2015;3:143-46.
[Google Scholar]

[38] Begum DF. Thyroid dysfunction and pregnancy outcome. IOSR.. 2016;15:07-10.
[CrossRef] [Google Scholar]

[39] Dhanwal DK, Bajaj S, Rajput R, Subramaniam KA, Chowdhury S, Bhandari R, et al. Prevalence of hypothyroidism in pregnancy: An epidemiological study from 11 cities in 9 states of India. Indian J Endocrinol Metab.. 2016;20:387-90.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[40] Mandal RC, Bhar D, Das A, Basunia SR, Kundu SB, Mahapatra C. Subclinical hypothyroidism in pregnancy: An emerging problem in southern West Bengal: A cross-sectional study. J Nat Sci Biol Med.. 2016;7:80-4.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[41] Saraladevi R, Nirmala Kumari T, Shreen B, Usha Rani V. Prevalence of thyroid disorder in pregnancy and pregnancy outcome. IMSEAR.. 2016;3:1-11.
[Google Scholar]

[42] Shivanagappa M, Mahadevaiah M, Rao G, Kondareddy T. Profile and feto-maternal outcomes of pregnant women with thyroid dysfunction: A prospective study from South India. Int J Reprod Contracept Obstet Gynecol.. 2016;5:4132-5.
[CrossRef] [Google Scholar]

[43] Singh G, Kaul I, Singh A. Pregnancy outcome in overt hypothyroidism. Int J Res Med Sci.. 2016;4:3997-4000.
[CrossRef] [Google Scholar]

[44] Tiwari D, Ruchika G, Anchal, Rani R. Prevalence of overt and subclinical hypothyroidism among Indian pregnant women and its effect on foetomaternal outcome. J Evolution Med Dent Sci.. 2016;5:3342-47.
[CrossRef] [Google Scholar]

[45] Dubey S, Pradhan A. Thyroid disorder in antenatal women in sub-himalayan region: A need for universal screening. Int J Reprod Contracept Obstet Gynecol.. 2017;6:3445.
[CrossRef] [Google Scholar]

[46] Gedam JK, Rajput DA. Prevalence of thyroid disorders among patients attending the antenatal clinic at tertiary care centre, Parel, Mumbai, India. Int J Reprod Contracept Obstet Gynecol.. 2017;6:1235-40.
[CrossRef] [Google Scholar]

[47] Indira G, Narasinga Rao T, Premavardhini Y. Prevalence of thyroid disorders in pregnancy at a teaching hospital. Jebmh.. 2017;4:64-70.
[CrossRef] [Google Scholar]

[48] Pokhanna J, Gupta U, Alwani M, Tiwari SP. Prevalence of thyroid dysfunction and impact on maternal and fetal outcome in central Indian pregnant women. Int J Reprod Contracept Obstet Gynecol.. 2017;6:4666.
[CrossRef] [Google Scholar]

[49] Sannaboraiah A, Upadhyaya R, Garag S, Krishnappa S. Subclinical hypothyroidism in pregnancy and outcomes. Int J Reprod Contracept Obstet Gynecol.. 2017;6:1215-21.
[CrossRef] [Google Scholar]

[50] Devi PU, Vanaja G. Maternal and perinatal outcome in antenatal women with hypothyroidism. IAIM.. 2017;4:199-207.
[Google Scholar]

[51] Bansal A, Saxena M, Bansal M. Study on prevalence of hypothyroidism in pregnancy in rural population of Pilkhuwa, Hapur, U.P. Indian J Obstet Gynecol Res.. 2025;5:82-5.
[Google Scholar]

[52] Gupta R, Agarwal S, Pandey K, Gupta N, Jahan U, Rao YK, et al. A clinical study on thyroid dysfunctions in pregnancy and its effect on maternal and neonatal outcome. Jemds.. 2018;7:1520-3.
[CrossRef] [Google Scholar]

[53] Hymavathi K, Gottipati MD, Jakka T, C. BT. Routine screening of antenatal population for thyroid disorders-mandatory. Int J Reprod Contracept Obstet Gynecol.. 2018;7:2834.
[Google Scholar]

[54] Korde VR, Barse SP, Barla JS. Prevalence of thyroid dysfunctions in pregnant women: A prospective study in a tertiary care hospital in Maharashtra, India. Int J Reprod Contracept Obstet Gynecol.. 2018;7:3211-5.
[CrossRef] [Google Scholar]

[55] Ananda Kumari M, Venkataramana K, Padma Leela K, Aafreen S, Amrin A. Prevalence of thyroid dysfunction among antenatal women in a teaching hospital. JEMDS.. 2018;7:441-5.
[CrossRef] [Google Scholar]

[56] Kumari A, Srivastav R, Mitra S. Prevalence of thyroid dysfunction and its effects on fetomaternal outcome in pregnant women of Eastern Uttar Pradesh, India. Int J Reprod Contracept Obstet Gynecol.. 2018;7:4379.
[CrossRef] [Google Scholar]

[57] Pahwa S, Mangat S. Prevalence of thyroid disorders in pregnancy. Int J Reprod Contracept Obstet Gynecol.. 2018;7:3493-6.
[CrossRef] [Google Scholar]

[58] Panda J, Maji A, Mishra J, Manjareeka M. Thyroid disorders in pregnancy: An exploratory study. Journal of Clinical and Diagnostic Research.. 2018;12:QC09-QC12.
[CrossRef] [Google Scholar]

[59] Pillai NS, Bennet J. Prevalence of hypothyroidism amongst pregnant women: A study done in rural set up. Int J Reprod Contracept Obstet Gynecol.. 2018;7:1586.
[CrossRef] [Google Scholar]

[60] Agrawal P, Mehta S, Gupta M, Khare P. Prevalence of hypothyroidism in the first trimester pregnancy in primigravida in North India. IJOGR.. 2019;6:68-70.
[CrossRef] [Google Scholar]

[61] Diyora V, Shah T, Mishra MK. Thyroid dysfunction in women during first trimester of pregnancy: Correlation with anti-thyroid peroxidase antibodies; Sch Int J Biochem. 2019. ;2:36-9.
[Google Scholar]

[62] Sharma D, Dixit PV, Gavit Y. Maternal and perinatal outcome in hypothyroidism in pregnancy: A prospective observational study. Int J Reprod Contracept Obstet Gynecol.. 2017;6:5548.
[CrossRef] [Google Scholar]

[63] Justin SA, Johnson MS. A prospective study on evaluation of maternal and foetal outcomes of hypothyroidism with levothyroxine and prevalence of hypothyroidism in pregnancy in a tertiary care teaching hospital in Kerala. Int J Basic Clin Pharmacol.. 2020;9:392-8.
[CrossRef] [Google Scholar]

[64] Mahadik K, Choudhary P, Roy PK. Study of thyroid function in pregnancy, its feto-maternal outcome: A Prospective Observational Study. 2020. ;20:769.
[Google Scholar]

[65] Mahajan K, Mahajan S. Study of thyroid disorders on maternal outcome in a rural tertiary care hospital. Pravara Med Rev.. 2020;12:67-72.
[Google Scholar]

[66] Ramachandra K, Gilyaru S, Eregowda A, Yathiraja S. Prevalence of refractive error and the eye morbidity in school children in Bangalore, India. Int J Contemp Pediatr.. 2016;3:138-41.
[CrossRef] [Google Scholar]

[67] Gupta P, Jain M, Verma V, Gupta NK. The study of prevalence and pattern of thyroid disorder in pregnant women: A prospective study. Cureus.. 2021;13:e16457.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[68] V S, S M, B M, M M. Prevalence of thyroid dysfunction among pregnant women in first trimester: A hospital-based study from Mysuru, South India. IJCRR.. 2021;13:127-33.
[CrossRef] [Google Scholar]

[69] Dash P, Tiwari R, Nayak S, Jena SK, Mangaraj M. Prevalence of subclinical hypothyroidism in pregnancy and its association with anti-thyroperoxidase antibody and the occurrence of gestational diabetes mellitus. Cureus.. 2022;14:e21087.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[70] R A, Kandasamy V, R S. Prevalence of hypothyroidism in first trimester screening and its association with maternal and foetal outcomes. Int J Reprod Contracept Obstet Gynecol.. 2023;12:2721-5.
[CrossRef] [Google Scholar]

[71] Bankapur DG, Yaliwal DRG, Bidri DSR, Kori DSS, Patil DNG, Shettar DSSK. Effect of maternal hypothyroidism on obstetric and perinatal outcome, an observational study. Int J Clin Obstet Gynaecol.. 2023;7:17-22.
[CrossRef] [Google Scholar]

[72] Debbarma R, Gothwal M, Singh P, Yadav G, Purohit P, Ghuman NK, et al. The spectrum of thyroid dysfunction during pregnancy and fetomaternal outcome, a study from the premier institute of western India. Indian J Community Med.. 2024;49:734-8.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[73] Kumar R, Bansal R, Shergill HK, Garg P. Prevalence of thyroid dysfunction in pregnancy and its association with feto-maternal outcomes: A prospective observational study from a tertiary care institute in Northern India. Clin Epidemiology Glob Health.. 2023;19:101201.
[CrossRef] [Google Scholar]

[74] Palepu S, Singh AK, Saharia GK, Patra S, Singh S, Taywade M, et al. Hypothyroidism in Pregnancy: An alarming concern in a rural community of eastern India. Indian J Community Med.. 2023;48:187-9.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[75] Vaishnav S, Pandya D, Shrivastava R, Patel N, Phatak AG, Patel A. Early treatment will prevent feto-maternal complications in thyroid disorders during pregnancy: A prospective study. J Family Med Prim Care.. 2023;12:3393-8.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[76] Das T, Das N, Bhowmick S, Biswas A. Prevalence and feto-maternal outcomes of subclinical hypothyroidism in pregnancy among mothers attending a tertiary care hospital of Darjeeling District, West Bengal, India. Asian J Med Sci.. 2024;15:123-8.
[CrossRef] [Google Scholar]

[77] Khawale R, Kanetkar SR, Patil M. Impact of hypothyroidism in pregnancy on feto-maternal outcomes: A Prospective observational study. Cureus.. 2024;16:e74494.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[78] Singh A, Prasad S, Prasad SG. Prevalence of hypothyroidism in pregnancy it’s impact on pregnancy outcome in a tertiary care center in Western Rajasthan: A prospective study. Int J Pharm Clin Res.. 2024;16:143-7.
[Google Scholar]

[79] Tejaswi A, Bharti MR, Boddu D, Devyani, Nihal A, Penugonda V. Prospective observational study on prevalence and treatment pattern of hypothyroidism during pregnancy: Research article. J Pharma Insights Res.. 2024;2:199-206.
[Google Scholar]

[80] Vamja R, M Y, Patel M, Vala V, Ramachandran A, Surati B, et al. Impact of maternal thyroid dysfunction on fetal and maternal outcomes in pregnancy: A prospective cohort study. Clin Diabetes Endocrinol.. 2024;10:50.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[81] Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid.. 2011;21:1081-125.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[82] Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 Guidelines of the American thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid.. 2017;27:315-89.
[CrossRef] [PubMed] [Google Scholar]

[83] Siscart J, Perejón D, Serna MC, Oros M, Godoy P, Sole E. Prevalence, risk factors, and consequences of hypothyroidism among pregnant women in the health region of Lleida: A cohort study. PLoS One.. 2023;18:e0278426.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[84] Natonal Health Mission. Ministry of Health & family Welfare, Government of India. National guidelines for screening of hypothyroidism during pregnancy. Available from: https://nhm.gov.in/images/pdf/programmes/maternal-health/guidelines/National_Guidelines_for_Screening_of_Hypothyroidism_during_Pregnancy.pdf, accessed on January 5, 2026.

[85] Metelli S, Chaimani A. Challenges in meta-analyses with observational studies. Evid Based Ment Health.. 2020;23:83-7.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

Prevalence of hypothyroidism among pregnant women and associated feto-maternal outcomes in India: Systematic review and meta-analysis

Abstract

Background and objectives

Methods

Results

Interpretation and conclusions

Keywords

Adverse effect

Hypothyroidism

India

Neonatal outcomes

Pregnant women

Prevalence

Pregnancy outcomes

Methods

Search strategy

Selection criteria

Screening and data extraction

Quality assessment

Data synthesis and management

Results

Thyroid dysfunction in pregnant women in India

Maternal hypothyroidism and pregnancy complications

Maternal hypothyroidism and adverse birth outcomes

Meta regression analysis

Publication bias

Discussion

Author contributions

Financial support and sponsorship

Conflicts of Interest

Use of Artificial Intelligence (AI)-Assisted Technology for manuscript preparation

References

Suggested read for related articles:

We value your privacy