REVIEW OF 51 PREGNANCIES IN PATIENTS WITH GRAVES-DISEASE

Fifty-one pregnancies in 41 patients with Graves' disease (1.24 per pa tient) were studied. Mean age was 29+/-5 years. Eighty-five per cent o f patients were married; 51% were pauciparous; 90% resided in urban or semiurban areas; and 69% were in the low or middle income brackets. S ymptoms of Graves' disease were present before the pregnancy in 86% of cases. The gestational age at which the diagnosis of the thyroid diso rder was established did not influence the frequency of the main manif estations; thyrotoxicosis was seen in over half the cases. The hyperth yroidism worsened during the pregnancy and Improved to some extent aft er delivery. From the prepregnancy period to the postpartal period, th e proportion of patients under carbimazole fell from 75% to 30%, and t he dose of the drug decreased from 26 to 18 mg/d. Data on the outcome of the pregnancy were available for 35 cases; there were 65% full-term births, 20% premature births, and 14% abortions. Toxemia of pregnancy was seen in 14% of cases. Of the 39 delivered infants, 58% were healt hy, 15% were stillborn, 5% were growth-retarded, 5% had macrosomia, an d 2% had birth defects; abortion occurred in 12% of cases. Factors ass ociated with an increased risk of premature delivery (maximum rate 43% ) were residence in a semiurban or rural area, low income, unmarried s tatus, young age of the mother, a short time interval between onset of Graves' disease and the pregnancy, failure to diagnose Graves' diseas e until after the pregnancy, poor thyroid function control with a slow heart rate or severe tachycardia; and absence of use of carbimazole. These same factors were predictive of maximal rates of fetal wastage ( 20% to 100%), intrauterine growth retardation (12.5% to 25%), and stil l-birth (15 to 50%).